October 24, 2024 • 42 mins
Explore innovative strategies for managing metabolic health with naturopath Carrun Squires, who holds a Master's in Human Nutrition and a Graduate Certificate in Diabetes Education. This episode delves into the rising prevalence of metabolic dysfunction in Australia, covering metabolic syndrome, pre-diabetes, and type 2 diabetes. Learn about early identification of metabolic issues, the latest in blood sugar monitoring, and practical interventions for optimal metabolic health.
Episode highlights:
- Metabolic syndrome: Early detection and prevention strategies
- MASLD: Understanding the new nomenclature for fatty liver disease
- Comprehensive assessments: Fasting insulin tests and continuous glucose monitoring
- Nutritional interventions: Fibre, vegetables, and key supplements
- Exercise strategies for improved glucose regulation
- Lifestyle factors influencing metabolic health
- Preventing cardiovascular and chronic kidney complications
- Practical application of continuous glucose monitors in patient care
About Carrun
Naturopath | Clinical Nutritionist |Diabetes Educator
Carrun Squires is a Naturopath who has worked in private clinical practice for seventeen years. Carrun is committed to supporting her patients in their quest to manage or be preventative in the areas of type 2 diabetes, pre-diabetes, metabolic syndrome and related complications such as cardiovascular disease.
In practice, when not supporting her own patients, Carrun has made it her mission to mentor other health practitioners in identifying when dysglycaemias may be the underlying cause of their own patient’s health issues.
Carrun has pursued post-graduate studies in the areas of human nutrition, diabetes education and lifestyle medicine. Applying this unique combination of complementary and mainstream understandings of blood sugar dysregulation sees Carrun providing a holistic approach empowering her clients to embrace change that can delay or arrest development of chronic disease.
Carrun has featured on podcasts and webinars discussing naturopathic treatment considerations and has spoken both nationally and internationally on lifestyle medicine and nutritional management of pre-diabetes and type 2 diabetes.
Connect with Carrun: Carrun Squires Naturopath
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:19):
Music.
This is Wellness by Designs,and I'm your host, andrew
Whitfield-Cook, and joining ustoday is Karen Squires, and
she's a naturopath who holds aMaster's in Human Nutrition and
also a Grad Cert in DiabetesEducation, and today we're going
to be speaking about effectivetreatment of patients with
metabolic dysfunction.
(00:40):
Welcome to Wellness by Designs,karen.
How are you?
I'm good.
Thank you for having me, karenit's my absolute pleasure.
Speaker 2 (00:43):
Welcome to Wellness by Designs, Karen.
How are you?
I'm good.
Speaker 1 (00:44):
Thank you for having me, karen, it's my absolute
pleasure.
Just for everybody who'slistening or watching in the
pre-chat that Karen and I had,this lady's knowledge is
extensive, so get ready.
This is going to be fun.
It's going to be reallyeducational for you.
So, karen, first of all, can wego back into history?
Speaker 2 (01:10):
Tell us a little bit about your career, because it
doesn't come from naturopathy,does it?
No, it doesn't.
Prior to becoming a naturopath,I was working as an executive
assistant to a senior exec at abig Australian corporate which I
loved.
I had always been interested inmedicine in health and natural
medicine as well, so I took aredundancy and I used the money
(01:33):
to study naturopathy full-timeand graduated in 2006 and been
in full-time practice ever since.
Speaker 1 (01:43):
Gotcha and you're down in Victoria, right.
Speaker 2 (01:49):
I'm, yes, down in Victoria, in the beautiful high
country of Victoria, up in thehills and the mountains.
Speaker 1 (01:56):
Yep, okay, so let's talk about metabolic dysfunction
.
Let's dive right in.
How big is this topic?
Like, how big an issue is thisin Australia?
We've got more than onedisorder here, correct?
Speaker 2 (02:18):
Yeah, that's right.
It's a really big issue.
In Australia.
I concentrate mainly onmetabolic dysfunction related to
blood sugar dysregulation, sousually driven by insulin
resistance.
So in clinical it will coverthings like metabolic syndrome,
(02:40):
non-alcoholic fatty liverdisease, pre-diabetes, type 2
diabetes.
The main driver, as I said,behind these is usually insulin
resistance.
Speaker 1 (02:54):
What's driving all of this, though, karen?
Speaker 2 (02:57):
The main drivers is our lifestyle, current lifestyle
.
So being sedentary or lowlevels of exercise, high caloric
diets, being overweight orobese especially that visceral
adiposity in particular that weget around the middle are the
biggest drivers.
90% of what we're seeing inclinic are these modifiable
(03:21):
drivers.
There are non-modifiabledrivers, such as aging.
So there are some things wecan't do anything about, but
most cases we actually can dosomething about them.
Speaker 1 (03:33):
What about genetics?
We know about the you know inthe olden days forgive me, it
was the OB-OB gene.
We know about geneticpredispositions for diabetes,
type 2 diabetes and evencarbohydrate harvesting and
obesity.
How important are these in, athe patient presentation and B
(04:00):
what you can control?
Speaker 2 (04:02):
There are genetic influences in obesity and
chronic disease like type 2diabetes, but given that most of
it 90% is our lifestyle andmodifiable, I concentrate on
that before I get to genetics.
It is something that I do liketo look at, but it's not
(04:29):
initially what I would startwith, you know, given the
presentation that I'll see inclinic.
So, for example, I can touch ona couple of the things that I
see in clinics, such asmetabolic syndrome, of the
(04:50):
things that I see in clinics,such as metabolic syndrome.
So this you know more than 35%of Australians have metabolic
syndrome, which is a cluster ofconditions that predisposes
people to type 2 diabetes,stroke and heart disease.
I think it's really importantfor us, as clinicians, to
ascertain whether our client hasmetabolic syndrome or not,
because it contributes to therisk of cardiovascular disease,
(05:12):
chronic kidney disease and type2 diabetes.
It type 2 diabetes is two tothree times higher and some
studies report up to five timeshigher than someone without
metabolic syndrome.
And and the diagnostics for thesyndrome are something that we
as clinicians see daily.
(05:34):
So, for example, an elevatedwaist circumference, elevated
triglycerides or medicated,reduced HDL or medicated,
elevated blood pressure ormedicated, fasting blood glucose
or medicated, and you only needthree of these.
So I see many people withmetabolic syndrome that don't
(05:56):
necessarily come in with this,but you'll pick this up with or
without their pathology results.
So you know.
Think about how many people wesee in clinic, for example, with
an elevated waist measurementon blood pressure medication and
with reduced HDR.
That's metabolic syndrome.
Speaker 1 (06:19):
Yeah, yeah, yeah.
Speaker 2 (06:21):
I think it's important for clinicians to pick
up on that because it's beenassociated with so many other
conditions like polycysticovarian syndrome, sleep apnea,
alzheimer's, some cancers aswell.
So, while it's a condition ofits own, I think you can also
view it as a bit of a canary inthe coal mine, alerting you to
(06:43):
other possible health issues.
So that's one of the metabolicdysfunctions that I like to pick
up in clinic.
Speaker 1 (06:54):
So how often do patients come in seeing you for
something totally distant tothis, but something about your
expertise tweaks and you go hangon for a tick.
We need to be, as you say,being the canary in the coal
mine.
What are the things that youlook at or notice that maybe
(07:15):
other clinicians don't?
Speaker 2 (07:18):
I don't know that I notice anything more than other
clinicians might.
Perhaps they're focused on thepresenting complaint which we
often get on paperwork evenbefore we see the client in
clinic.
So we can already tell a lotabout the client before we see
(07:40):
them.
You know their age, whatmedication they might be on.
We may even be able to knowwhat ethnicity they are, what
family history, et cetera, sothat already before we see the
client in clinic can kind of,you know, just alert us.
They might be coming for a skincondition or a gut condition,
(08:04):
but you know once they walk inthe door if they're overweight
they have that high waistmeasurement, certainly if
they're bringing PATH results orif they're sent to you prior to
an initial consultation, whichhappens often as well.
Certainly, seeing a trend insomething like rising fasting
(08:24):
blood glucose, even if it's notout of the range yet, should
alert a practitioner intolooking a little bit further.
Speaker 1 (08:34):
Gotcha, gotcha.
So let's go further into thispatient presentation, because
where I'm going to go here isoutliers, and the reason I say
this is when I'm going to gohere is outliers.
And the reason I say this ismature age couple, retired,
(08:58):
quite wealthy, no stress, verypositive attitude to life,
healthy lifestyle, healthyeating habits.
The wife came in to see me notlong ago and has been diagnosed
with fatty liver.
Out of the blue there was noindication that we could see and
I have no idea at this stagewhy, you know.
Let's talk about outliers Likewhat things tweak you to this
(09:21):
sort of thing where you gosomething's weird?
What things tweak you to thissort of thing where you go
something's weird?
Speaker 2 (09:29):
Is it that rising glucose, as you say, it can be
Also high insulin as well, soshe wasn't overweight, normal
weight, very healthy.
Speaker 1 (09:41):
She was flawed.
She was not an alcohol drinker.
It was a very funnypresentation and I wondered
about medications passed oranything like that.
I don't know.
Speaker 2 (09:56):
Yeah, or something viral perhaps, or she could just
be an outlier.
The nomenclature fornon-alcoholic fatty liver
disease just changed last year,so they've actually taken the
alcoholic and the fatty out ofthe term because they found that
that was not really reflectiveof what was going on and also a
(10:18):
bit stigmatising.
So within that new nomenclaturethere is some little
subcategories and one of thosesubcategories is someone who
does not fit.
So there could be a geneticinfluence there as well.
But if it's a diagnosis offatty liver disease and if she
(10:41):
has um had a you know a scan toto have a look at the extent of
that, whether she's an outlieror not, you would still want to
support healthy liver function.
You know healthy detox pathwaysum, any inflammatory um.
Speaker 1 (11:00):
You know nature of, of, of what she's got going on
as well yeah, yeah, with thenomenclature like it used to be
non-alcoholic fatty liverdisease, I thought try and find
a non-alcoholic person inaustralia, but anyway.
So the nomenclature has changedand and I think it was um
massiled.
Is that right?
(11:20):
So metabolic associated it'smetabolic dysfunction.
Yeah, what was it sorryassociated?
Speaker 2 (11:27):
steatotic.
Yeah sorry, it's metabolicdysfunction associated steatotic
liver disease.
So that's muscle d, and thenthere's mash as well yeah,
non-alcoholic steatohepatosis,that's it, yeah, yeah.
(11:52):
Okay, sorry you were going tosay something, karen.
It's still an issue in a personlike an outlier.
So what's driven that?
May be genetic.
She's an outlier.
However, the liver fat isassociated.
You know it is veryinflammatory.
It's associated with impairedliver clearance of insulin.
(12:13):
The liver is actually the mainorgan for liver clearance.
So I would want to be wantingto keep an eye on blood sugar
levels and insulin levels aswell, given that she would have
fatty liver.
Yeah, it's usually drivenmainly by obesity, but yeah, you
(12:35):
know, we are going to get thoseoutliers occasionally.
Speaker 1 (12:38):
Yeah.
So what about assessments?
Let's go into them.
You've spoken about fastinginsulin, which is very rarely
done by GPs.
Do you just order it yourself?
Speaker 2 (12:54):
I do both.
I will ask my patient whetherthey have a good open
relationship with their GP andwhether they feel comfortable in
asking the GP to do that.
Uh, if not, uh, I'll do itmyself, but I you know, fasting
blood glucose with insulin isreally important to get those
(13:18):
two together yeah, that's yourhomo ir right yeah, yeah,
definitely.
so it'll give us a degree ofinsulin resistance.
But also you can see people who, like your outlier, um, have a
healthy weight, uh, have ahealthy diet, have a healthy
lifestyle, um, and have anormal-looking, fasting blood
(13:44):
glucose, but their insulinlevels might be off the scale,
holding them there, okay, oh.
So the reason that that'simportant to know is that even
in a normal glycemic environment, if the insulin is too high,
(14:07):
it's still going to drive thosedyslipidemias and cardiovascular
problems.
Speaker 1 (14:14):
Yeah, yeah.
So other assessments.
So we've got that HOMA-IR, theinsulin resistance test.
What about things likecontinuous glucose monitoring?
We're seeing that more and moreused by healthy or otherwise
healthy people not necessarilydiagnosed diabetics and it's
(14:37):
just amazing.
Like, for instance, kiraSutherland uses them quite often
in athletes and is amazed atthe results.
Yeah, so now, forgive me, I'veforgotten his name, tim, I can't
remember his name.
He was a long-distance runner,south African.
He got attacked by a dieticianfor him giving dietary advice.
(14:59):
He won that case some years agoForgive me, sir, I can't
remember your full name and he,even though being extremely fit,
had type 2 diabetes, had type 2diabetes.
So it's not just that robustbody people who have the type 2
(15:24):
diabetes or that insulinresistance I should say.
So how much further do you goin, like your intake form, to
pick up on things that arealluding to glycemic malfunction
?
Let's say, you know, lunchtimeafter lunchtime, tiredness,
brain fog, that sort of thing.
(15:46):
Do you look at these sort ofweird vague symptoms to maybe
pick up and look further?
Speaker 2 (15:53):
I do, once I have a client in clinic, go through
what signs and symptoms thatthey might have.
There's a lot that we can do inin clinic to pick up on on
things like here.
I do use CGM continuous glucosemonitors as well, not on every
(16:14):
single person but it, you know,a fasting blood glucose is
really just telling us how wellour liver coped in the fasting
state overnight.
You know, with the cgm we canreally get greater insight than
just fasting blood glucose, uh,an insight on in in how your
(16:34):
body is actually responding tonot just food but stress and
exercise.
Uh, and most, most clients, Ifind, uh, using a cgm is
extremely motivating for them,like they can actually see in
real time, um, you know, the,the, the dietary and lifestyle
(16:55):
choices that they're making.
And you know, tech like this isthe future of health, I think,
and there's several platformsout there now that are
integrating other diagnostics,like Fitbits and Our Rings, and
they're bringing it togetherwith CGMs to get a really
(17:17):
holistic view of a person'shealth.
And, you know, bringing it alltogether with sleep and heart
rate and blood pressure and allof these kind of things with the
CGM, and I think it reallyhelps me and other practitioners
who are using them to targetinterventions, you know, because
we can start to see the trends.
(17:39):
You know we're not just seeinga fasting blood glucose and a
fasting insulin, which are bothimportant together, but that
doesn't tell us what's happeningduring the day.
So starting to see where thetrends are, starting to see what
glucose variability there isduring the day, can really help
(17:59):
us to assess what's going on.
And you know, at the momentthese are only subsidised for
certain people, so people arebuying them off the internet.
Otherwise, well, people, and Ireally think that will change, I
think we'll see that change.
Technology really is the futureof health here.
Speaker 1 (18:21):
Yeah, I must, just as a caveat or as a warning, I
must say they're not infallible.
I have seen probably the mostcommon thing is that they fall
off after about a week or so.
So particularly those peoplethat might sweat during their
work bricklayers, tradies,athletes they have to ensure
(18:42):
that they've taped it on andcontinue to tape it on over the
two-week period.
The other thing is I havenoticed in a few people they're
doing fingerprint glucosemonitoring as well and comparing
it and it may not correlateexactly.
I've seen sometimes a bit of avariance.
It's not massive but there is avariance.
Speaker 2 (19:07):
And there should be a variance, because the
continuous glucose monitor ismonitoring interstitial fluid,
which lags behind blood glucoseby about five to ten minutes, so
it will eventually catch up.
It will eventually catch up.
It'll be five to ten minutesbehind.
So, um, if there is somebodywith type 2 diabetes and the the
(19:30):
glucose monitor is telling themthat, uh, their blood sugar is
currently high and there's alittle arrow on the monitor that
shows you if it's stabilisingor if it's going higher, if
they're quite concerned, theyshould do a blood sugar check,
you know, like a glucometer,because that will give them
closer to what their realcurrent blood sugar is, whether
(19:55):
it is actually still going up.
Speaker 1 (19:57):
Just as a last bit on pathology, Karen, what other
pathology tests are of use?
They show a part of the picture.
Speaker 2 (20:08):
Just on a standard pathology test, I obviously
would.
Still, you know, there will bethe fasting blood glucose,
hopefully fasting insulin, whichwe can use to work out insulin
resistance.
The HOMA-IR Important to have alook at EGFR to keep an eye on
(20:32):
kidney function If somebody doeshave type 2 diabetes.
Chronic kidney disease is a,you know, a common complication
of type 2 diabetes.
Vitamin D even can be important.
Beta cells, pancreatic betacells, have vitamin D receptors.
So I always make sure you knowvitamin D is optimal.
(20:59):
If you have a patient onmetformin, for example, whether
it's for PCOS or type 2 diabetesor pre-diabetes.
B12 is important to keep an eyeon as well, because metformin
inhibits the intestinalabsorption of B12.
Looking at some inflammatorymarkers like CRP looking at some
(21:19):
inflammatory markers like crp,hba1c, to let us know how the
body has been dealing with itsglucose load over the last
couple of months.
Iron studies as well can beimportant um very high irons, a
risk factor for type 2 diabetes.
So there are some standardassessments on general pathology
tests that can inform us alsoliver function, for example.
(21:42):
All of these things can give usa little bit of a picture that
we can put together with theclient sitting in front of us.
Speaker 1 (21:49):
Karen, can I ask, speaking about iron studies, can
I ask about ferritin?
Do you see a high ferritinbeing a risk factor?
And b?
Do you see, during therapy,ferritin decreasing to a normal
level if it's elevated?
Speaker 2 (22:08):
I I have done from In the studies.
It can I don't want to saycause type 2 diabetes, but it
has been associated with highiron environments.
(22:31):
But ferritin can be that falsepositive for inflammation as
well.
So if we start and type 2diabetes is a very pro-oxidant
and inflammatory condition sowhen we start to, you know,
reduce some of that inflammation, we can see some ferritin, you
(22:51):
know, can see that go down.
Speaker 1 (22:55):
You're right, gotcha.
Okay, and so to therapy.
So now we've got so many thingsthat we can talk about here.
Where do you start?
Obviously, it's got to bedietary driven.
How do you change a diet,though?
Because that's the probably thebiggest hurdle you're ever
going to encounter.
Speaker 2 (23:14):
How do I change a diet?
Cgms do really help, as I saidearlier, as a motivating factor.
And, yes, diet and lifestyle isabsolutely foundational to the
treatment of metabolicdysfunction.
(23:35):
Look, it can be difficult withdiet, but talking somebody
through the benefits ofincreasing their fibre intake,
increasing their vegetableintake, and talking to them
about the diversity of food thatthey, you know, rather than
(23:57):
taking things out, I tried tocrowd more in so that we can,
you know, diversify, especiallythe plant component of their
diet, given that a lot ofmetabolic dysfunction is driven
by, you know, highly processedfoods and things like that.
So it's more about gettingthings in and talking to them
(24:20):
about the different colours inthe food.
Actually, you know, we spokeabout genetics earlier.
These colours in the food arevery important signalling
chemicals that turn onprotective functions, you know,
within the body yeah, yeah, sure, um, and so what about um
(24:46):
supplements?
Speaker 1 (24:47):
you know, um, I was speaking earlier to someone
about insulin resistance andmetabolic um, we were talking
about the importance ofmyo-inositol.
Now, this was mainly in femalesthey were talking about, but
when you're talking about bothmales and females, do you have
any like top five go-tosupplements that you might
choose?
Speaker 2 (25:10):
Nutritionals and herbals as well.
So myo-inositol is really,really interesting, actually
it's.
You know, we do produce it inour bodies and we also get some
in our diet.
But uh, with somebody whoalready has type 2 diabetes
there's an increased urinaryloss.
Plus there's also decreased umabsorption or penetration into
(25:35):
the cells.
So kidneys and the retina.
I mentioned earlier about thecomplications of type 2 diabetes
being nephropathy.
So kidney disease andretinopathy.
They're both depleted in type 2diabetes in myo-inositol.
(25:58):
So I did see a study thatshowed supplementation with that
may help to prevent or delaydevelopment of those
microcomplications.
It's particularly, I think ofmyo-inositol, particularly for
insulin resistance.
I think of myo-inositolparticularly for insulin
resistance.
(26:18):
It's particularly good inslowing glucose absorption but
it improves the muscle uptake,so it really improves that
insulin sensitivity.
So myo-inositol for insulinresistance.
For me, another one of mygo-tos would be magnesium,
(26:38):
especially for cardiovascular.
You know, cardiovascular health, nervous system health and
function, muscle function,energy production, all those
things, uh, especiallycarbohydrate metabolism, blood
sugar support.
Yeah, magnesium is commonlydeficient in people with type 2
(26:58):
diabetes.
They have increased urinarylosses.
They have increased urinaryloss of magnesium.
So it's often a requirement.
Speaker 1 (27:12):
Yeah, what about the old things?
We used to use chromium andsome of the lipotropic factors?
We're restricted in Australiato the good forms of chromium,
as in the polynicotinate and thepicolinate, to 50 micrograms
per day dosing.
How do you get around this?
(27:33):
What do you tend to use withchromium as a dose?
Speaker 2 (27:37):
this might not be included, andrew, but I've never
actually really used chromium.
I've only I've never used it asa single supplement.
I've only ever used it as incombination.
You know it might already be insomething that I'm prescribing.
Speaker 1 (27:54):
Gotcha.
And what about herbs likeberberine?
Speaker 2 (27:58):
Oh, herbs like berberine, definitely.
Berberine is particularly ago-to of mine.
It's fantastic for increasinginsulin sensitivity.
It's also been shown to have apositive impact on body weight.
Also some of those umdyslipidemias like triglycerides
(28:22):
, for example.
It actually has an, even thoughit works different to metformin
.
It has an insulizing, insulinsensitizing sorry action similar
to metformin but, as I said,it's a different mechanism.
So it can actually you be usedalone or in conjunction with
metformin.
(28:42):
So, um, it's very safe there.
Um, berberine has actually beenshown to be as effective as
metformin in lowering fasting,blood glucose and HbA1c and some
of those dyslipidemias that wesee.
So, yeah, berberine isdefinitely a go-to as well.
(29:04):
I also really like turmeric asan anti-inflammatory helps that
inflammatory cascade that youknow it's a very inflammatory
environment type 2 diabetes andturmeric works very well here,
(29:28):
increasing insulin sensitivity.
It also protects themicrocirculation.
Also protects themicrocirculation so that chronic
kidney disease, nephrology andthe neuropathy that we see too.
Speaker 1 (29:44):
That peripheral neuropathy.
Speaker 2 (29:52):
Anything else that we need to discover?
I really like to use PEA, right.
So this is interesting.
I found PEA yeah, I really liketo use PEA.
It's anti-inflammatory but it'sanalgesic, so it's really good
for that neuralgic pain and Ihave used it in peripheral
(30:15):
neuropathy and had goodresponses.
Uh, with that, um, you know,peripheral neuropathy in type 2
diabetes is, um, it's the what'sthe word?
It's the highest indicator ofmortality, uh, once somebody has
(30:35):
that peripheral neuropathy andthat nerve damage.
So, uh, relieving some of thatdiscomfort for people is is
really important and it's so, papardon it's really painful for
people.
It's really painful, it canaffect their sleep as well,
(31:00):
because it actually seems to beworse at night.
The thing that people don'trealise with neuropathy in type
2 diabetes is, you know, weusually think of the peripheral
neuropathy, so the hands and thefeet and the toes, but it also
has an autonomic effect where itcan affect, um blood pressure
(31:21):
control, which is one of thethings that we're trying to to
manage in um these metabolic,yeah, issues, uh also
temperature control andsensation, digestion, bladder
function, sexual sexual function.
So, people, it's not just handsand fingers and toes and, you
(31:48):
know, as it advances, it is, youknow, the highest cause of
amputation.
Right?
Speaker 1 (31:53):
gotcha In type 2 diabetes.
What about lipoic acid?
How often do you employ it?
What dose do you go to?
Speaker 2 (32:01):
Do you know, andrew?
I didn't put anything forlipoic acid.
Speaker 1 (32:05):
No, it's okay, but do you ever like forget about the
notes?
Don't read off the notes, so doyou use it in clinic?
Speaker 2 (32:16):
I use lipoic acid in clinic for kidney support.
Speaker 1 (32:23):
Right, okay, and do you so?
Are you guided by EGFR withthat?
Speaker 2 (32:28):
Yes, I am.
Actually.
I can't recall off the top ofmy head where that needs to be
for that or what dosage I use.
But I remember a particularclient of mine recently that I
looked up some some recentresearch on and it was
definitely indicated for chronickidney disease.
(32:49):
Her EGFR, I think, was down tosay 28 or 30, something like
that.
So it's quite low.
She is very overweight.
She doesn't have type 2diabetes but she is very
overweight and has quite anumber of different disorders
(33:11):
going on.
But alpha-lipo acid has isdefinitely indicated for
supporting healthy kidneyfunction.
That filtration rate karen.
Speaker 1 (33:25):
What other nutraceuticals or nutrients do
you tend to incorporate, likefor instance we haven't
discussed zinc?
Speaker 2 (33:32):
no, we haven't discussed zinc.
I don't usually prescribe zincseparately.
It's usually in a formulation.
Perhaps it could already be inthe magnesium or another
combination that I'm using.
Zinc is really important in type2 diabetes.
It's really important for Imentioned earlier about
(33:56):
clearance of insulin out of thebody and there is an enzyme
that's responsible for that.
That is zinc dependent, so it'simportant to keep zinc levels
good.
Other nutritionals that I woulduse would include omegas
omega-3s obviously veryanti-inflammatory and very good
(34:20):
for modulating blood fats, whichis important in type 2 diabetes
.
And we know that the DHAcomponent is really important
for eye health.
So most people with type 2diabetes will actually get some
degree of diabetic retinopathyonce they've been diagnosed at
(34:43):
some stage some degree.
So that's really protective forthat as well.
And you know, we know, thatomega-3s improve you know that
cell membrane fluidity justgenerally, and that helps all
our cells communicate uh muchmore efficiently really
important for cardiovascularhealth as well karen, forgive me
(35:05):
, I never covered this off and Ishould have covered this off
right at the beginning exercise.
Speaker 1 (35:09):
We haven't even covered it.
How do you get people toexercise?
What sort of exercises are mostbeneficial for them?
Speaker 2 (35:16):
uh, yeah, it's true, I'll see people in clinic that
often aren't doing any exerciseat all.
So I'll start very simply.
Start very simply.
A lot of people, when theythink exercise, they think that
that means I've got to go outand walk for an hour or I've got
to hit the gym or somethinglike that.
But if it's somebody who hasn'texercised for a long time and
(35:39):
they're quite sedentary, then Ireally want to make it part of
their lifestyle.
So I want them to adopt iteasily.
So, even if it's five minutes,it's about making it part of the
routine, of of, you know, thenew, the new lifestyle.
So, even if it's just fiveminutes and I'll just encourage
(36:00):
people to do that they thinkit's not enough.
But just any level of activityis beneficial.
It will, you know, upregulatethe glucose into the muscle
cells.
They'll start to feel a littlebit better is beneficial.
It will, you know, upregulatethe glucose into the muscle
(36:21):
cells.
Um, it'll, they'll start tofeel a little bit better.
There's, um, once again, astudy I'm a bit of a nerd.
I like reading studies um, thatshowed as little as three
minutes a day of walking willshow benefit.
Will show benefit.
It was as little as just threeminutes on a lunch break of
walking um.
(36:42):
And also very light bouts ofresistance exercise, such as
standing up from your desk andjust doing a few squats, for
example.
Or you don't even have to leaveyour office room, you can go to
up to the wall and just do someyou know pushes against the
wall.
That very light intensityexercise for somebody to start
(37:03):
off with has been shown to be ofbenefit as far as glucose
regulation goes.
And then they can start tobuild on that.
And if they're wearing a CGM aswell, you know, if they're
wearing a CGM as well, you knowif they're wearing a continuous
glucose monitor as well, andthey start to actually see that
oh, I didn't think five minutesa day would make any difference.
(37:25):
And they can actually start tosee that these choices it's not
all dietary choices, it'slifestyle choices starts to have
, you know, an impact andbecomes very motivating for them
to build on that.
Speaker 1 (37:42):
Yeah, I couldn't agree with you more the number
of times I've spoken to patientsand it doesn't have to be this
massive group hit therapy witheverybody at the gym.
It doesn't have to be that, itcan be.
Simply, these people often areout of tune and so I don't want
to be placing them into asituation where they're going to
be over pressurizing their,over-exerting their system and
(38:05):
putting themselves at healthrisk.
So I often talk about exactlywhat you said just doing a
push-up quote unquote againstthe kitchen bench, or holding
onto the kitchen bench and doinga squat as far as they can
handle with their knees, simplethings like that.
I love what you've said aboutthat exercise for three minutes
a day because it's priming theirsystem.
(38:25):
It's priming them for not justtheir system physically, but
encouragingly.
If you're talking about thecontinuous glucose monitoring, I
love it.
Speaker 2 (38:39):
And we want them to be successful.
You know we don't want to makeit hard.
You know we want them toachieve the small goals because
when they do that they feelmotivated and they feel
confident in tackling the nextgoal, whatever that might be.
So you know, they may increasefrom walking for five minutes a
day to 10 minutes a day.
(39:00):
And I often tell my clients aswell don't go Dr Googling, don't
listen to what your friend saysor your mom says or whoever
says.
This is your own personaljourney.
And if 10 minutes is workingfor you, then you just do 10
minutes and I just tell themthat I want them to be
successful, I want them toachieve that goal and then you
(39:22):
know, as I said, they will havethe confidence then to tackle
the next one.
Speaker 1 (39:27):
Beautifully said.
Just a last point about redflags and potential medication
interactions.
What do we have to be aware of?
Speaker 2 (39:36):
I know that there's a lot of clinicians out there
that are really concerned aboutprescribing nutritionals or
herbal medicines with, you know,common anti-diabetic drugs.
But I haven't come across, Icertainly haven't had the
situation where I've personallyexperienced a negative
(39:57):
interaction with any of myclients, and in fact a lot of
the studies show, if we usemetformin as an example, being
one of the most commonmedications for metabolic
dysfunction, in fact, some ofour herbs, such as curcumin and
nigella berberine, they've allbeen shown to work very strongly
(40:22):
synergistically with metformin.
So yeah, you know, they workvery well together.
In fact, I think it wasactually with berberine that it
can be prescribed alongsidemetformin.
(40:43):
But as an example of how it canpotentiate the effects of
metformin, if it's prescribedtwo hours prior to somebody
taking their metformin, themetformin will actually last a
little bit longer than if theydidn't take the berberine.
So it increased the.
(41:03):
I can't remember the mechanism,but it increased the
bioavailability of the metforminwhen it was dosed a couple of
hours in advance.
So, yeah, yeah, it's, you know,know, like ginkgo and metformin.
Um, I've looked at that becauseI use ginkgo for, uh, kidney
(41:25):
support, the microcirculationthere, and it's been shown to
work together very well withmetformin in in reducing fasting
, blood glucose, bmi, waistcircumference, so they work very
well synergistically together.
I've never had um an adverse uhcombination effect.
(41:46):
Um, in fact it's.
It's it's often.
You know the pharmaceuticaldrugs that have the side effect.
So, talking about metformin, 30percent of people on metformin
will have gut issues with it.
So there'll be, nausea, diarrhea, yeah, even vomiting, um, in
some people.
So, uh, it's, it's a, it's a.
(42:09):
It's a safe environment toprescribe our herbs and they
work very, very stronglysynergistically with a lot of
the diabetes medications.
Speaker 1 (42:21):
Karen, thank you so much for taking us through this
today.
I know that we bit off way morethan what we could chew.
This is such a huge topic andwe've only covered a small part
of it.
It's like a three podcastseries, but thank you so much
for taking us through yourexpertise today.
I really appreciate it.
You're very welcome, thank youthrough your expertise today.
Speaker 2 (42:36):
I really appreciate it.
Speaker 1 (42:36):
You're very welcome, thank you and thank you everyone
for joining us today.
Remember you can catch up onthis podcast.
We'll put in the show notes asmuch information as we can, and
all the other podcasts are onthe Designs for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
Music.
This is Wellness by Designs,and I'm your host, andrew
Whitfield-Cook, and joining ustoday is Karen Squires, and
she's a naturopath who holds aMaster's in Human Nutrition and
also a Grad Cert in DiabetesEducation, and today we're going
to be speaking about effectivetreatment of patients with
metabolic dysfunction.
(00:40):
Welcome to Wellness by Designs,karen.
How are you?
I'm good.
Thank you for having me, karenit's my absolute pleasure.
Speaker 2 (00:43):
Welcome to Wellness by Designs, Karen.
How are you?
I'm good.
Speaker 1 (00:44):
Thank you for having me, karen, it's my absolute
pleasure.
Just for everybody who'slistening or watching in the
pre-chat that Karen and I had,this lady's knowledge is
extensive, so get ready.
This is going to be fun.
It's going to be reallyeducational for you.
So, karen, first of all, can wego back into history?
Speaker 2 (01:10):
Tell us a little bit about your career, because it
doesn't come from naturopathy,does it?
No, it doesn't.
Prior to becoming a naturopath,I was working as an executive
assistant to a senior exec at abig Australian corporate which I
loved.
I had always been interested inmedicine in health and natural
medicine as well, so I took aredundancy and I used the money
(01:33):
to study naturopathy full-timeand graduated in 2006 and been
in full-time practice ever since.
Speaker 1 (01:43):
Gotcha and you're down in Victoria, right.
Speaker 2 (01:49):
I'm, yes, down in Victoria, in the beautiful high
country of Victoria, up in thehills and the mountains.
Speaker 1 (01:56):
Yep, okay, so let's talk about metabolic dysfunction
.
Let's dive right in.
How big is this topic?
Like, how big an issue is thisin Australia?
We've got more than onedisorder here, correct?
Speaker 2 (02:18):
Yeah, that's right.
It's a really big issue.
In Australia.
I concentrate mainly onmetabolic dysfunction related to
blood sugar dysregulation, sousually driven by insulin
resistance.
So in clinical it will coverthings like metabolic syndrome,
(02:40):
non-alcoholic fatty liverdisease, pre-diabetes, type 2
diabetes.
The main driver, as I said,behind these is usually insulin
resistance.
Speaker 1 (02:54):
What's driving all of this, though, karen?
Speaker 2 (02:57):
The main drivers is our lifestyle, current lifestyle
.
So being sedentary or lowlevels of exercise, high caloric
diets, being overweight orobese especially that visceral
adiposity in particular that weget around the middle are the
biggest drivers.
90% of what we're seeing inclinic are these modifiable
(03:21):
drivers.
There are non-modifiabledrivers, such as aging.
So there are some things wecan't do anything about, but
most cases we actually can dosomething about them.
Speaker 1 (03:33):
What about genetics?
We know about the you know inthe olden days forgive me, it
was the OB-OB gene.
We know about geneticpredispositions for diabetes,
type 2 diabetes and evencarbohydrate harvesting and
obesity.
How important are these in, athe patient presentation and B
(04:00):
what you can control?
Speaker 2 (04:02):
There are genetic influences in obesity and
chronic disease like type 2diabetes, but given that most of
it 90% is our lifestyle andmodifiable, I concentrate on
that before I get to genetics.
It is something that I do liketo look at, but it's not
(04:29):
initially what I would startwith, you know, given the
presentation that I'll see inclinic.
So, for example, I can touch ona couple of the things that I
see in clinics, such asmetabolic syndrome, of the
(04:50):
things that I see in clinics,such as metabolic syndrome.
So this you know more than 35%of Australians have metabolic
syndrome, which is a cluster ofconditions that predisposes
people to type 2 diabetes,stroke and heart disease.
I think it's really importantfor us, as clinicians, to
ascertain whether our client hasmetabolic syndrome or not,
because it contributes to therisk of cardiovascular disease,
(05:12):
chronic kidney disease and type2 diabetes.
It type 2 diabetes is two tothree times higher and some
studies report up to five timeshigher than someone without
metabolic syndrome.
And and the diagnostics for thesyndrome are something that we
as clinicians see daily.
(05:34):
So, for example, an elevatedwaist circumference, elevated
triglycerides or medicated,reduced HDL or medicated,
elevated blood pressure ormedicated, fasting blood glucose
or medicated, and you only needthree of these.
So I see many people withmetabolic syndrome that don't
(05:56):
necessarily come in with this,but you'll pick this up with or
without their pathology results.
So you know.
Think about how many people wesee in clinic, for example, with
an elevated waist measurementon blood pressure medication and
with reduced HDR.
That's metabolic syndrome.
Speaker 1 (06:19):
Yeah, yeah, yeah.
Speaker 2 (06:21):
I think it's important for clinicians to pick
up on that because it's beenassociated with so many other
conditions like polycysticovarian syndrome, sleep apnea,
alzheimer's, some cancers aswell.
So, while it's a condition ofits own, I think you can also
view it as a bit of a canary inthe coal mine, alerting you to
(06:43):
other possible health issues.
So that's one of the metabolicdysfunctions that I like to pick
up in clinic.
Speaker 1 (06:54):
So how often do patients come in seeing you for
something totally distant tothis, but something about your
expertise tweaks and you go hangon for a tick.
We need to be, as you say,being the canary in the coal
mine.
What are the things that youlook at or notice that maybe
(07:15):
other clinicians don't?
Speaker 2 (07:18):
I don't know that I notice anything more than other
clinicians might.
Perhaps they're focused on thepresenting complaint which we
often get on paperwork evenbefore we see the client in
clinic.
So we can already tell a lotabout the client before we see
(07:40):
them.
You know their age, whatmedication they might be on.
We may even be able to knowwhat ethnicity they are, what
family history, et cetera, sothat already before we see the
client in clinic can kind of,you know, just alert us.
They might be coming for a skincondition or a gut condition,
(08:04):
but you know once they walk inthe door if they're overweight
they have that high waistmeasurement, certainly if
they're bringing PATH results orif they're sent to you prior to
an initial consultation, whichhappens often as well.
Certainly, seeing a trend insomething like rising fasting
(08:24):
blood glucose, even if it's notout of the range yet, should
alert a practitioner intolooking a little bit further.
Speaker 1 (08:34):
Gotcha, gotcha.
So let's go further into thispatient presentation, because
where I'm going to go here isoutliers, and the reason I say
this is when I'm going to gohere is outliers.
And the reason I say this ismature age couple, retired,
(08:58):
quite wealthy, no stress, verypositive attitude to life,
healthy lifestyle, healthyeating habits.
The wife came in to see me notlong ago and has been diagnosed
with fatty liver.
Out of the blue there was noindication that we could see and
I have no idea at this stagewhy, you know.
Let's talk about outliers Likewhat things tweak you to this
(09:21):
sort of thing where you gosomething's weird?
What things tweak you to thissort of thing where you go
something's weird?
Speaker 2 (09:29):
Is it that rising glucose, as you say, it can be
Also high insulin as well, soshe wasn't overweight, normal
weight, very healthy.
Speaker 1 (09:41):
She was flawed.
She was not an alcohol drinker.
It was a very funnypresentation and I wondered
about medications passed oranything like that.
I don't know.
Speaker 2 (09:56):
Yeah, or something viral perhaps, or she could just
be an outlier.
The nomenclature fornon-alcoholic fatty liver
disease just changed last year,so they've actually taken the
alcoholic and the fatty out ofthe term because they found that
that was not really reflectiveof what was going on and also a
(10:18):
bit stigmatising.
So within that new nomenclaturethere is some little
subcategories and one of thosesubcategories is someone who
does not fit.
So there could be a geneticinfluence there as well.
But if it's a diagnosis offatty liver disease and if she
(10:41):
has um had a you know a scan toto have a look at the extent of
that, whether she's an outlieror not, you would still want to
support healthy liver function.
You know healthy detox pathwaysum, any inflammatory um.
Speaker 1 (11:00):
You know nature of, of, of what she's got going on
as well yeah, yeah, with thenomenclature like it used to be
non-alcoholic fatty liverdisease, I thought try and find
a non-alcoholic person inaustralia, but anyway.
So the nomenclature has changedand and I think it was um
massiled.
Is that right?
(11:20):
So metabolic associated it'smetabolic dysfunction.
Yeah, what was it sorryassociated?
Speaker 2 (11:27):
steatotic.
Yeah sorry, it's metabolicdysfunction associated steatotic
liver disease.
So that's muscle d, and thenthere's mash as well yeah,
non-alcoholic steatohepatosis,that's it, yeah, yeah.
(11:52):
Okay, sorry you were going tosay something, karen.
It's still an issue in a personlike an outlier.
So what's driven that?
May be genetic.
She's an outlier.
However, the liver fat isassociated.
You know it is veryinflammatory.
It's associated with impairedliver clearance of insulin.
(12:13):
The liver is actually the mainorgan for liver clearance.
So I would want to be wantingto keep an eye on blood sugar
levels and insulin levels aswell, given that she would have
fatty liver.
Yeah, it's usually drivenmainly by obesity, but yeah, you
(12:35):
know, we are going to get thoseoutliers occasionally.
Speaker 1 (12:38):
Yeah.
So what about assessments?
Let's go into them.
You've spoken about fastinginsulin, which is very rarely
done by GPs.
Do you just order it yourself?
Speaker 2 (12:54):
I do both.
I will ask my patient whetherthey have a good open
relationship with their GP andwhether they feel comfortable in
asking the GP to do that.
Uh, if not, uh, I'll do itmyself, but I you know, fasting
blood glucose with insulin isreally important to get those
(13:18):
two together yeah, that's yourhomo ir right yeah, yeah,
definitely.
so it'll give us a degree ofinsulin resistance.
But also you can see people who, like your outlier, um, have a
healthy weight, uh, have ahealthy diet, have a healthy
lifestyle, um, and have anormal-looking, fasting blood
(13:44):
glucose, but their insulinlevels might be off the scale,
holding them there, okay, oh.
So the reason that that'simportant to know is that even
in a normal glycemic environment, if the insulin is too high,
(14:07):
it's still going to drive thosedyslipidemias and cardiovascular
problems.
Speaker 1 (14:14):
Yeah, yeah.
So other assessments.
So we've got that HOMA-IR, theinsulin resistance test.
What about things likecontinuous glucose monitoring?
We're seeing that more and moreused by healthy or otherwise
healthy people not necessarilydiagnosed diabetics and it's
(14:37):
just amazing.
Like, for instance, kiraSutherland uses them quite often
in athletes and is amazed atthe results.
Yeah, so now, forgive me, I'veforgotten his name, tim, I can't
remember his name.
He was a long-distance runner,south African.
He got attacked by a dieticianfor him giving dietary advice.
(14:59):
He won that case some years agoForgive me, sir, I can't
remember your full name and he,even though being extremely fit,
had type 2 diabetes, had type 2diabetes.
So it's not just that robustbody people who have the type 2
(15:24):
diabetes or that insulinresistance I should say.
So how much further do you goin, like your intake form, to
pick up on things that arealluding to glycemic malfunction
?
Let's say, you know, lunchtimeafter lunchtime, tiredness,
brain fog, that sort of thing.
(15:46):
Do you look at these sort ofweird vague symptoms to maybe
pick up and look further?
Speaker 2 (15:53):
I do, once I have a client in clinic, go through
what signs and symptoms thatthey might have.
There's a lot that we can do inin clinic to pick up on on
things like here.
I do use CGM continuous glucosemonitors as well, not on every
(16:14):
single person but it, you know,a fasting blood glucose is
really just telling us how wellour liver coped in the fasting
state overnight.
You know, with the cgm we canreally get greater insight than
just fasting blood glucose, uh,an insight on in in how your
(16:34):
body is actually responding tonot just food but stress and
exercise.
Uh, and most, most clients, Ifind, uh, using a cgm is
extremely motivating for them,like they can actually see in
real time, um, you know, the,the, the dietary and lifestyle
(16:55):
choices that they're making.
And you know, tech like this isthe future of health, I think,
and there's several platformsout there now that are
integrating other diagnostics,like Fitbits and Our Rings, and
they're bringing it togetherwith CGMs to get a really
(17:17):
holistic view of a person'shealth.
And, you know, bringing it alltogether with sleep and heart
rate and blood pressure and allof these kind of things with the
CGM, and I think it reallyhelps me and other practitioners
who are using them to targetinterventions, you know, because
we can start to see the trends.
(17:39):
You know we're not just seeinga fasting blood glucose and a
fasting insulin, which are bothimportant together, but that
doesn't tell us what's happeningduring the day.
So starting to see where thetrends are, starting to see what
glucose variability there isduring the day, can really help
(17:59):
us to assess what's going on.
And you know, at the momentthese are only subsidised for
certain people, so people arebuying them off the internet.
Otherwise, well, people, and Ireally think that will change, I
think we'll see that change.
Technology really is the futureof health here.
Speaker 1 (18:21):
Yeah, I must, just as a caveat or as a warning, I
must say they're not infallible.
I have seen probably the mostcommon thing is that they fall
off after about a week or so.
So particularly those peoplethat might sweat during their
work bricklayers, tradies,athletes they have to ensure
(18:42):
that they've taped it on andcontinue to tape it on over the
two-week period.
The other thing is I havenoticed in a few people they're
doing fingerprint glucosemonitoring as well and comparing
it and it may not correlateexactly.
I've seen sometimes a bit of avariance.
It's not massive but there is avariance.
Speaker 2 (19:07):
And there should be a variance, because the
continuous glucose monitor ismonitoring interstitial fluid,
which lags behind blood glucoseby about five to ten minutes, so
it will eventually catch up.
It will eventually catch up.
It'll be five to ten minutesbehind.
So, um, if there is somebodywith type 2 diabetes and the the
(19:30):
glucose monitor is telling themthat, uh, their blood sugar is
currently high and there's alittle arrow on the monitor that
shows you if it's stabilisingor if it's going higher, if
they're quite concerned, theyshould do a blood sugar check,
you know, like a glucometer,because that will give them
closer to what their realcurrent blood sugar is, whether
(19:55):
it is actually still going up.
Speaker 1 (19:57):
Just as a last bit on pathology, Karen, what other
pathology tests are of use?
They show a part of the picture.
Speaker 2 (20:08):
Just on a standard pathology test, I obviously
would.
Still, you know, there will bethe fasting blood glucose,
hopefully fasting insulin, whichwe can use to work out insulin
resistance.
The HOMA-IR Important to have alook at EGFR to keep an eye on
(20:32):
kidney function If somebody doeshave type 2 diabetes.
Chronic kidney disease is a,you know, a common complication
of type 2 diabetes.
Vitamin D even can be important.
Beta cells, pancreatic betacells, have vitamin D receptors.
So I always make sure you knowvitamin D is optimal.
(20:59):
If you have a patient onmetformin, for example, whether
it's for PCOS or type 2 diabetesor pre-diabetes.
B12 is important to keep an eyeon as well, because metformin
inhibits the intestinalabsorption of B12.
Looking at some inflammatorymarkers like CRP looking at some
(21:19):
inflammatory markers like crp,hba1c, to let us know how the
body has been dealing with itsglucose load over the last
couple of months.
Iron studies as well can beimportant um very high irons, a
risk factor for type 2 diabetes.
So there are some standardassessments on general pathology
tests that can inform us alsoliver function, for example.
(21:42):
All of these things can give usa little bit of a picture that
we can put together with theclient sitting in front of us.
Speaker 1 (21:49):
Karen, can I ask, speaking about iron studies, can
I ask about ferritin?
Do you see a high ferritinbeing a risk factor?
And b?
Do you see, during therapy,ferritin decreasing to a normal
level if it's elevated?
Speaker 2 (22:08):
I I have done from In the studies.
It can I don't want to saycause type 2 diabetes, but it
has been associated with highiron environments.
(22:31):
But ferritin can be that falsepositive for inflammation as
well.
So if we start and type 2diabetes is a very pro-oxidant
and inflammatory condition sowhen we start to, you know,
reduce some of that inflammation, we can see some ferritin, you
(22:51):
know, can see that go down.
Speaker 1 (22:55):
You're right, gotcha.
Okay, and so to therapy.
So now we've got so many thingsthat we can talk about here.
Where do you start?
Obviously, it's got to bedietary driven.
How do you change a diet,though?
Because that's the probably thebiggest hurdle you're ever
going to encounter.
Speaker 2 (23:14):
How do I change a diet?
Cgms do really help, as I saidearlier, as a motivating factor.
And, yes, diet and lifestyle isabsolutely foundational to the
treatment of metabolicdysfunction.
(23:35):
Look, it can be difficult withdiet, but talking somebody
through the benefits ofincreasing their fibre intake,
increasing their vegetableintake, and talking to them
about the diversity of food thatthey, you know, rather than
(23:57):
taking things out, I tried tocrowd more in so that we can,
you know, diversify, especiallythe plant component of their
diet, given that a lot ofmetabolic dysfunction is driven
by, you know, highly processedfoods and things like that.
So it's more about gettingthings in and talking to them
(24:20):
about the different colours inthe food.
Actually, you know, we spokeabout genetics earlier.
These colours in the food arevery important signalling
chemicals that turn onprotective functions, you know,
within the body yeah, yeah, sure, um, and so what about um
(24:46):
supplements?
Speaker 1 (24:47):
you know, um, I was speaking earlier to someone
about insulin resistance andmetabolic um, we were talking
about the importance ofmyo-inositol.
Now, this was mainly in femalesthey were talking about, but
when you're talking about bothmales and females, do you have
any like top five go-tosupplements that you might
choose?
Speaker 2 (25:10):
Nutritionals and herbals as well.
So myo-inositol is really,really interesting, actually
it's.
You know, we do produce it inour bodies and we also get some
in our diet.
But uh, with somebody whoalready has type 2 diabetes
there's an increased urinaryloss.
Plus there's also decreased umabsorption or penetration into
(25:35):
the cells.
So kidneys and the retina.
I mentioned earlier about thecomplications of type 2 diabetes
being nephropathy.
So kidney disease andretinopathy.
They're both depleted in type 2diabetes in myo-inositol.
(25:58):
So I did see a study thatshowed supplementation with that
may help to prevent or delaydevelopment of those
microcomplications.
It's particularly, I think ofmyo-inositol, particularly for
insulin resistance.
I think of myo-inositolparticularly for insulin
resistance.
(26:18):
It's particularly good inslowing glucose absorption but
it improves the muscle uptake,so it really improves that
insulin sensitivity.
So myo-inositol for insulinresistance.
For me, another one of mygo-tos would be magnesium,
(26:38):
especially for cardiovascular.
You know, cardiovascular health, nervous system health and
function, muscle function,energy production, all those
things, uh, especiallycarbohydrate metabolism, blood
sugar support.
Yeah, magnesium is commonlydeficient in people with type 2
(26:58):
diabetes.
They have increased urinarylosses.
They have increased urinaryloss of magnesium.
So it's often a requirement.
Speaker 1 (27:12):
Yeah, what about the old things?
We used to use chromium andsome of the lipotropic factors?
We're restricted in Australiato the good forms of chromium,
as in the polynicotinate and thepicolinate, to 50 micrograms
per day dosing.
How do you get around this?
(27:33):
What do you tend to use withchromium as a dose?
Speaker 2 (27:37):
this might not be included, andrew, but I've never
actually really used chromium.
I've only I've never used it asa single supplement.
I've only ever used it as incombination.
You know it might already be insomething that I'm prescribing.
Speaker 1 (27:54):
Gotcha.
And what about herbs likeberberine?
Speaker 2 (27:58):
Oh, herbs like berberine, definitely.
Berberine is particularly ago-to of mine.
It's fantastic for increasinginsulin sensitivity.
It's also been shown to have apositive impact on body weight.
Also some of those umdyslipidemias like triglycerides
(28:22):
, for example.
It actually has an, even thoughit works different to metformin
.
It has an insulizing, insulinsensitizing sorry action similar
to metformin but, as I said,it's a different mechanism.
So it can actually you be usedalone or in conjunction with
metformin.
(28:42):
So, um, it's very safe there.
Um, berberine has actually beenshown to be as effective as
metformin in lowering fasting,blood glucose and HbA1c and some
of those dyslipidemias that wesee.
So, yeah, berberine isdefinitely a go-to as well.
(29:04):
I also really like turmeric asan anti-inflammatory helps that
inflammatory cascade that youknow it's a very inflammatory
environment type 2 diabetes andturmeric works very well here,
(29:28):
increasing insulin sensitivity.
It also protects themicrocirculation.
Also protects themicrocirculation so that chronic
kidney disease, nephrology andthe neuropathy that we see too.
Speaker 1 (29:44):
That peripheral neuropathy.
Speaker 2 (29:52):
Anything else that we need to discover?
I really like to use PEA, right.
So this is interesting.
I found PEA yeah, I really liketo use PEA.
It's anti-inflammatory but it'sanalgesic, so it's really good
for that neuralgic pain and Ihave used it in peripheral
(30:15):
neuropathy and had goodresponses.
Uh, with that, um, you know,peripheral neuropathy in type 2
diabetes is, um, it's the what'sthe word?
It's the highest indicator ofmortality, uh, once somebody has
(30:35):
that peripheral neuropathy andthat nerve damage.
So, uh, relieving some of thatdiscomfort for people is is
really important and it's so, papardon it's really painful for
people.
It's really painful, it canaffect their sleep as well,
(31:00):
because it actually seems to beworse at night.
The thing that people don'trealise with neuropathy in type
2 diabetes is, you know, weusually think of the peripheral
neuropathy, so the hands and thefeet and the toes, but it also
has an autonomic effect where itcan affect, um blood pressure
(31:21):
control, which is one of thethings that we're trying to to
manage in um these metabolic,yeah, issues, uh also
temperature control andsensation, digestion, bladder
function, sexual sexual function.
So, people, it's not just handsand fingers and toes and, you
(31:48):
know, as it advances, it is, youknow, the highest cause of
amputation.
Right?
Speaker 1 (31:53):
gotcha In type 2 diabetes.
What about lipoic acid?
How often do you employ it?
What dose do you go to?
Speaker 2 (32:01):
Do you know, andrew?
I didn't put anything forlipoic acid.
Speaker 1 (32:05):
No, it's okay, but do you ever like forget about the
notes?
Don't read off the notes, so doyou use it in clinic?
Speaker 2 (32:16):
I use lipoic acid in clinic for kidney support.
Speaker 1 (32:23):
Right, okay, and do you so?
Are you guided by EGFR withthat?
Speaker 2 (32:28):
Yes, I am.
Actually.
I can't recall off the top ofmy head where that needs to be
for that or what dosage I use.
But I remember a particularclient of mine recently that I
looked up some some recentresearch on and it was
definitely indicated for chronickidney disease.
(32:49):
Her EGFR, I think, was down tosay 28 or 30, something like
that.
So it's quite low.
She is very overweight.
She doesn't have type 2diabetes but she is very
overweight and has quite anumber of different disorders
(33:11):
going on.
But alpha-lipo acid has isdefinitely indicated for
supporting healthy kidneyfunction.
That filtration rate karen.
Speaker 1 (33:25):
What other nutraceuticals or nutrients do
you tend to incorporate, likefor instance we haven't
discussed zinc?
Speaker 2 (33:32):
no, we haven't discussed zinc.
I don't usually prescribe zincseparately.
It's usually in a formulation.
Perhaps it could already be inthe magnesium or another
combination that I'm using.
Zinc is really important in type2 diabetes.
It's really important for Imentioned earlier about
(33:56):
clearance of insulin out of thebody and there is an enzyme
that's responsible for that.
That is zinc dependent, so it'simportant to keep zinc levels
good.
Other nutritionals that I woulduse would include omegas
omega-3s obviously veryanti-inflammatory and very good
(34:20):
for modulating blood fats, whichis important in type 2 diabetes
.
And we know that the DHAcomponent is really important
for eye health.
So most people with type 2diabetes will actually get some
degree of diabetic retinopathyonce they've been diagnosed at
(34:43):
some stage some degree.
So that's really protective forthat as well.
And you know, we know, thatomega-3s improve you know that
cell membrane fluidity justgenerally, and that helps all
our cells communicate uh muchmore efficiently really
important for cardiovascularhealth as well karen, forgive me
(35:05):
, I never covered this off and Ishould have covered this off
right at the beginning exercise.
Speaker 1 (35:09):
We haven't even covered it.
How do you get people toexercise?
What sort of exercises are mostbeneficial for them?
Speaker 2 (35:16):
uh, yeah, it's true, I'll see people in clinic that
often aren't doing any exerciseat all.
So I'll start very simply.
Start very simply.
A lot of people, when theythink exercise, they think that
that means I've got to go outand walk for an hour or I've got
to hit the gym or somethinglike that.
But if it's somebody who hasn'texercised for a long time and
(35:39):
they're quite sedentary, then Ireally want to make it part of
their lifestyle.
So I want them to adopt iteasily.
So, even if it's five minutes,it's about making it part of the
routine, of of, you know, thenew, the new lifestyle.
So, even if it's just fiveminutes and I'll just encourage
(36:00):
people to do that they thinkit's not enough.
But just any level of activityis beneficial.
It will, you know, upregulatethe glucose into the muscle
cells.
They'll start to feel a littlebit better is beneficial.
It will, you know, upregulatethe glucose into the muscle
(36:21):
cells.
Um, it'll, they'll start tofeel a little bit better.
There's, um, once again, astudy I'm a bit of a nerd.
I like reading studies um, thatshowed as little as three
minutes a day of walking willshow benefit.
Will show benefit.
It was as little as just threeminutes on a lunch break of
walking um.
(36:42):
And also very light bouts ofresistance exercise, such as
standing up from your desk andjust doing a few squats, for
example.
Or you don't even have to leaveyour office room, you can go to
up to the wall and just do someyou know pushes against the
wall.
That very light intensityexercise for somebody to start
(37:03):
off with has been shown to be ofbenefit as far as glucose
regulation goes.
And then they can start tobuild on that.
And if they're wearing a CGM aswell, you know, if they're
wearing a CGM as well, you knowif they're wearing a continuous
glucose monitor as well, andthey start to actually see that
oh, I didn't think five minutesa day would make any difference.
(37:25):
And they can actually start tosee that these choices it's not
all dietary choices, it'slifestyle choices starts to have
, you know, an impact andbecomes very motivating for them
to build on that.
Speaker 1 (37:42):
Yeah, I couldn't agree with you more the number
of times I've spoken to patientsand it doesn't have to be this
massive group hit therapy witheverybody at the gym.
It doesn't have to be that, itcan be.
Simply, these people often areout of tune and so I don't want
to be placing them into asituation where they're going to
be over pressurizing their,over-exerting their system and
(38:05):
putting themselves at healthrisk.
So I often talk about exactlywhat you said just doing a
push-up quote unquote againstthe kitchen bench, or holding
onto the kitchen bench and doinga squat as far as they can
handle with their knees, simplethings like that.
I love what you've said aboutthat exercise for three minutes
a day because it's priming theirsystem.
(38:25):
It's priming them for not justtheir system physically, but
encouragingly.
If you're talking about thecontinuous glucose monitoring, I
love it.
Speaker 2 (38:39):
And we want them to be successful.
You know we don't want to makeit hard.
You know we want them toachieve the small goals because
when they do that they feelmotivated and they feel
confident in tackling the nextgoal, whatever that might be.
So you know, they may increasefrom walking for five minutes a
day to 10 minutes a day.
(39:00):
And I often tell my clients aswell don't go Dr Googling, don't
listen to what your friend saysor your mom says or whoever
says.
This is your own personaljourney.
And if 10 minutes is workingfor you, then you just do 10
minutes and I just tell themthat I want them to be
successful, I want them toachieve that goal and then you
(39:22):
know, as I said, they will havethe confidence then to tackle
the next one.
Speaker 1 (39:27):
Beautifully said.
Just a last point about redflags and potential medication
interactions.
What do we have to be aware of?
Speaker 2 (39:36):
I know that there's a lot of clinicians out there
that are really concerned aboutprescribing nutritionals or
herbal medicines with, you know,common anti-diabetic drugs.
But I haven't come across, Icertainly haven't had the
situation where I've personallyexperienced a negative
(39:57):
interaction with any of myclients, and in fact a lot of
the studies show, if we usemetformin as an example, being
one of the most commonmedications for metabolic
dysfunction, in fact, some ofour herbs, such as curcumin and
nigella berberine, they've allbeen shown to work very strongly
(40:22):
synergistically with metformin.
So yeah, you know, they workvery well together.
In fact, I think it wasactually with berberine that it
can be prescribed alongsidemetformin.
(40:43):
But as an example of how it canpotentiate the effects of
metformin, if it's prescribedtwo hours prior to somebody
taking their metformin, themetformin will actually last a
little bit longer than if theydidn't take the berberine.
So it increased the.
(41:03):
I can't remember the mechanism,but it increased the
bioavailability of the metforminwhen it was dosed a couple of
hours in advance.
So, yeah, yeah, it's, you know,know, like ginkgo and metformin.
Um, I've looked at that becauseI use ginkgo for, uh, kidney
(41:25):
support, the microcirculationthere, and it's been shown to
work together very well withmetformin in in reducing fasting
, blood glucose, bmi, waistcircumference, so they work very
well synergistically together.
I've never had um an adverse uhcombination effect.
(41:46):
Um, in fact it's.
It's it's often.
You know the pharmaceuticaldrugs that have the side effect.
So, talking about metformin, 30percent of people on metformin
will have gut issues with it.
So there'll be, nausea, diarrhea, yeah, even vomiting, um, in
some people.
So, uh, it's, it's a, it's a.
(42:09):
It's a safe environment toprescribe our herbs and they
work very, very stronglysynergistically with a lot of
the diabetes medications.
Speaker 1 (42:21):
Karen, thank you so much for taking us through this
today.
I know that we bit off way morethan what we could chew.
This is such a huge topic andwe've only covered a small part
of it.
It's like a three podcastseries, but thank you so much
for taking us through yourexpertise today.
I really appreciate it.
You're very welcome, thank youthrough your expertise today.
Speaker 2 (42:36):
I really appreciate it.
Speaker 1 (42:36):
You're very welcome, thank you and thank you everyone
for joining us today.
Remember you can catch up onthis podcast.
We'll put in the show notes asmuch information as we can, and
all the other podcasts are onthe Designs for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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