Wisdom Wednesday: A1C Test

The A1C is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you’re managing your diabetes. The A1C test goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c.

The test result reflects your average blood sugar level for the past two months. Specifically, the A1C test measures what percentage of your hemoglobin – a protein in red blood cells that carries oxygen – is coat with coated with sugar (glycated). The higher the A1C level, the poorer the blood sugar control and the higher the risk of diabetes complications. Because red blood cells (RBCs) live approximately 120 days, the half life of an RBC is 60 days. So the test measures the saturation of sugar into RBCs over that 60 day average.

Recently an international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that the A1C test be the primary test used to diagnose prediabetes, type 1 and type 2 diabetes. Previously, the fasting glucose was the gold standard. However, in many cases the A1C elevates years prior to the fasting glucose. It is estimated that there are 35 million undiagnosed cases of type 2 diabetes in the United States alone.

The medical norm for the A1C test is less than 5.7%. That corresponds to an average blood sugar level, in milligram per deciliter (mg/dL) of 117. Research reveals anything above that level causes damage to the kidneys, small blood vessels, nerves and the eyes. A test result of 6.5%, the threshold for diabetes, reflects an average blood sugar level of 140.

A1C levels above 5.7 but below 6.5 are considered pre-diabetes. This is where many of my patients land, if they are not yet true diabetics. This is also where early treatment in the form of dietary improvements, regular exercise, and supplementation will easily reduce the A1C below 5.7% and allow patients to avoid Type 2 diabetes.

Wisdom Wednesday: Black Current Seed Oil

Black current seed oil is an omega 6 fatty acid. Just like the omega 3 fatty acids, omega 6s are essential. Humans can not create the double bond at the 3rd carbon or the 6th carbon from the terminal end of the fatty acid. So both must be in the diet.

Unlike omega 3 fatty acids, there are plenty of sources of omega 6 fatty acids in our diet. Olive, corn, soy, sunflower, and safflower oils are all rich in omega 6s. Unfortunately, most of these oils also contain saturated fats that are not so healthy.

In addition, many of us can not convert the linoleic acid (omega 6) into gamma linolenic acid (GLA) to be used by the body. Alcohol, saturated fats, trans-fats, deficiencies of vitamin B3, B6 or zinc, some chemicals and some viral infections can block the chemical pathway for conversion. As we age, as stress increases, or when any of the factors of metabolic syndrome appear, this process becomes less efficient. GLA can also be diverted into the arachidonic acid pathway by these same factors, increasing inflammation body wide. (Please review my blog on Sesame Seed Oil)

The abundance in the diet, poor conversion to GLA, and tendency to be pro-inflammatory in nature has led most nutritionist to recommend against supplementation of omega 6 fatty acids. However, I disagree with their reasoning and often recommend black current seed oil. I believe you need to correct the metabolic errors rather than deny an essential nutrient to the body.

Wisdom Wednesday: Sesame Seed Oil

Now that I have finished my review of the QA (Quintessential Applications), I will return to describing some of my favorite supplements on Wednesday Wisdom.

In the omega 6 fatty acid pathway, long chain molecules are first converted to GLA (gamma linolenic acid). This process is often impaired by poor diet, viral infections, age, alcohol use, and various B vitamin deficiencies. You can support omega 6 fatty acid metabolism by supplementing black current seed oil, borage oil, or evening primrose oil. All three of these supplements are high in GLA. My personal preference is black current seed oil.

Once your body has acquired GLA, vitamin B6 acts as a catalyst to convert it to DGLA. At this point a highly significant crossroad is reached. In a healthy state, the body then converts DGLA into anti-inflammatory prostaglandins (PG1). However, when insulin resistance, hypothyroidism, hyperlipidemia, or any aspect of metabolic syndrome is present, the DGLA is converted to pro-inflammatory PG2.

Wisdom Wednesday: The Pancreas

The pancreas is the last organ in the endocrine system that we evaluate. We began with the endocrine system as a whole – adrenal, pineal/pituitary, thyroid, and reproduction. Then we looked at hidden adrenal issues. Last week we reviewed liver function; now finally, the pancreas.

The head of the pancreas secretes digestive enzymes. Digestion will be discussed next week. The tail of the pancreas secretes insulin and other hormones. Insulin binds to glucose in the blood stream and facilitates entry to most cells of the body.

Over the course of our lives, most of us become insulin resistant. Excess refined carbohydrates and just eating too much in general tax the system. Insulin receptors in the cells of the body become less responsive to insulin so the pancreas must produce ever increasing quantities of insulin to force sugar into the cells. This is early stage Type II Diabetes.

Eventually, the pancreas just wears out, insulin production falls and the body becomes dependent on insulin injections to maintain some semblance of glucose control.

There are four tissues that do not require insulin to absorb glucose – the small capillaries, the kidneys, the nervous system and the eyes. These tissues are saturated with excess glucose for years prior to the diagnosis of diabetes. The result is progressive degeneration of these tissues resulting in neuropathy, blindness, amputation of the lower extremities, kidney failure, and ultimately death.

It is estimated that by the year 2050, 50% of the US population will be diabetic. Diabetes is an epidemic that is preventable and often reversible just by making good choices in diet and exercise.

When evaluating the pancreas, we correlate function with the remainder of the endocrine system. Sometimes pancreas dysfunction is secondary to an adrenal issue or a thyroid problem. However, most commonly, the problem begins with general inflammation.

When the body is inflamed, from just about any cause, it produces arachidonic acid. This most frequently results in the production of prostaglandins (PG2), primarily from the liver. (Please review my first Wednesday Wisdom blog on QA evaluation, “Inflammation – part 1”, posted on March 19, 2014) Adequate intake of omega 3 and omega 6 fatty acids should produce PG3 and PG1 respectively, which counterbalance the inflammation from PG2. However, early on in insulin resistance, the conversion of healthy omega 6 fatty acids from the diet is shunted into the arachidonic acid pathway creating more inflammation rather than less.

Supplementation with sesame seed oil prevents this shunting and restores the omega 6 to PG1 pathway. This simple change in body chemistry often dramatically improves glucose metabolism, even in drug dependent diabetics.

In resistant cases, the herb Gymnema can be most effective. Gymnema actually helps restore the beta cells of the pancreas that secrete insulin. In Ayurvedic medicine, Gymnema means “sugar destroyer”. For thousands of years, it has been used to eliminate the sickly sweet smell of urine produced when diabetics spill glucose into the urine in an attempt to reduce blood levels.

THE BOTTOM LINE:
If you are not yet diabetic, the odds are quite good that you will become one. Have your glycohemoglobin A1c checked yearly. It will detect problems in glucose metabolism years before the fasting glucose is out of control and the diagnosis of diabetes is given. Maintain a regime of regular exercise and reduce the refined carbohydrates in your diet.

If you have a blood sugar issue, no matter how advanced, consult with a qualified nutritionist. The damage begins long before you are aware you have a problem. However, it can be reversed with proper guidance.

Inflammation – Friend or Foe?

A vast majority of medical care is aimed at reducing inflammation. It’s not just the anti-inflammatory drugs like cortisone, Aleve, and Advil. Pain killers, anti-histamines, like Benadryl, and even some chemotherapy drugs all target inflammation. Inflammation has five characteristics – pain, swelling, heat, redness of the overlying skin, and loss of motion. Reducing inflammation will improve some or all of these symptoms.

MY TAKE:
Inflammation is the body’s first response to injury. It is protective in nature, brings attention to the injury and forces you to support the healing process. Without inflammation, damage would continue unabated as evidenced by the progressive damage in leprosy. Lepers are unaware of minor injuries because of the infection in their nervous system (Hansen’s Bacillus). Simple cuts and bruises go unattended causing the severe damage that horribly disfigures the victims.

Today, however, inflammation runs unchecked. Our bodies are losing the basic chemistry designed to curb and control inflammation. There are six well identified inflammatory pathways in the human body. Prostaglandins (PG2) are the most common. When an injury occurs, arachadonic acid is released by the damaged cells. This produces PG2 both in the injury site and in the liver to stimulate body wide inflammation. Once the inflammation has served its purpose, the body releases other prostaglandins (PG1 and PG3) to reduce the inflammation. PG1 & 3s are made by the body from essential fatty acids, PG1 from omega 6 fatty acids and PG3 from omega 3 fatty acids. They are considered essential because we can not manufacture omega 3 and 6 fatty acids in our body. They must be in the diet. However, omega 3 fatty acids are the most common nutritional deficiency in the US today. Although we still have a lot of omega 6 fatty acids in our diet, common health issues have altered the chemistry of the body. Most of us now convert healthy omega 6 fatty acids into arachadonic acid, creating more inflammation rather than less.

The overuse of NSAIDS, like Aleve and Advil compounds this problem. NSAIDS block PG2 reducing inflammation. However, within 3 days of use, they also block the PG1 and PG3 series that control inflammation. The result – 16,500 people in the US die every year from the unbridled inflammation caused by taking NSAIDS. Most of them bleed to death internally, the rest die from liver failure or heart attack.

Red meat used to be a source of omega 3 fatty acids. But when you feed cattle grains rather than grass, they can no longer produce omega 3 fatty acids. The same thing has happened to farm raised fish. Tilapia contain little or no omega 3 fatty acids because they are raised on corn meal.

THE BOTTOM LINE:
Taking 2,000mg of omega 3 fatty acids every day can be a great benefit. Avoid NSAIDS. If they must be used limit the use to three days or less and increase your omega 3 fatty acids. If you have any signs of metabolic syndrome – overweight, insulin resistance, high blood pressure, or high serum lipids, consider talking to your doctor or nutritionist about taking some sesame seed oil daily. This will block the conversion of omega 6 fatty acids into PG2 and encourage production of PG1.