My Notes From the Diabetes Summit
An Interview with Dr. Peter Osborne
Advanced Functional Testing for Personalized Diabetes Care
Conventional testing for diabetes is very limited by the time these standard tests come back abnormal they have already had a blood sugar problem or a pre-diabetes problem for several decades. The test in essence measures end stage disease they don’t measure early onset disease, what happens is we maybe could have sat down with that patient ten or twenty years prior and told them they need to start changing their diet. We could have run some functional laboratory to isolate and identify blood sugar abnormalities much earlier on. I think if were going to start we really have to understand how a persons micronutrient levels play a roll in blood sugar regulation, when I say micronutrients in layman’s terms it really means vitamins and minerals. People don’t realize the average doctor spends less that seven hours in the nine to eleven years of schooling on nutrition, so there is very little knowledge for the endocrinologist or the internal medicine doctors perspective on how nutrition, vitamins and minerals play a roll on the regulation of insulin, the regulation of glucose and the generating of energy from glucose. It’s a fundamental thing to have a good understanding of the biochemical nutritional background of the way the process works.
One of the primary tests that I would look at to give me some of that information is called the micronutrient array and the lab I use is called Spectra Cell Labs. What they measure is B vitamins and what we hear about B vitamins is they are good for energy, why are they good for energy, because B vitamins help in the breakdown process of glucose. We have glucose that we have to get into our cells and then our cells can convert that glucose into energy if we can’t get the glucose into our cells then our blood gets too syrupy, too sticky, we can develop aging byproducts AGE is an acronym for advanced glycation end product. What it does is it makes your blood really sticky and it makes a lot of the proteins in your blood and they don’t work as well, now we have binding and sugar moieties to proteins. If you have sugar bind to testosterone and your a guy that’s going to cause muscle loss it’s going to reduce your ability for your testosterone to really work. If your a female and you have sugar binding to thyroid hormones and estrogen hormones, remember hormones are proteins these hormones are not going to work as well and your going to get hormone abnormalities in addition to the already abnormal blood sugar. Understand if we go back to micronutrients and the process of eating where we eat the food and some of the food is broken down into glucose which is the general term for sugar in the blood. When glucose gets into the bloodstream it has to then trigger an insulin response.
Insulin is kind of like a key it opens up our cells and there’s a doorway in the cell wall that allows for glucose to get out of the blood and come into the cell. A big part of that doorway is vitamin B3, that goes back to what I was saying about B vitamins you can’t open the door for cellular glucose without B3 and a lot of doctors actually will prescribe vitamin B3 or niacin. They will do that to help lower total cholesterol because one of the side effects of niacin is it lowers LDL cholesterol, raises HDL’s and lowers triglycerides. It has some profound effects on lipids, more importantly it opens the cellular door to let glucose into the cell. Now that we’ve got glucose into the cell we have to break it down we don’t just magically create energy out of the glucose at that point. There are a couple of different processes that go on and one of those processes are large quantities of vitamins B1, B2 and B3 in addition to that we need vitamins B5, B6, B9, B12 and biotin. So in order to take that glucose and generate it into that final stage and convert that into energy we have to have all those B vitamins in the cell in their proper place doing their job effectively. If a person doesn’t have adequate quantities of B vitamins let’s just use the example of vitamin B1, what’s going to end up happening is their going to get the glucose to a point where it’s not fully broken down and so their not going to generate the energy and their going to become very fatigued and sluggish. Their metabolism is going to slow down they will have a tendency or predisposition to weight gain if we follow that process for ten or fifteen years we get weight gain, were tired all the time so that’s a deterrent to exercise. Now our blood sugars are abnormal, already were gaining weight , we don’t feel the energy to make us capable to exercise. Now we take away the one thing we can do externally to improve blood sugar which is physical activity because we have a biochemical imbalance. You let five years go by you have five extra pounds, you let five more years go by and maybe were 15-20 pounds and this is where metabolic syndrome can start to set in and really become diagnosed. We could have stopped that a long time ago, stopped it at fatigue which is a lot easier to do than to wait for fifteen years of blood sugar dysregulation. That’s going to create a lot of cellular damage, it’s going to create a lot of other problems.
That’s just B vitamins now we have vitamin D which is another micronutrient, vitamin D is what tells the pancreas to make insulin. If somebody has a vitamin D deficiency that one deficiency is enough to cause diabetes if left alone and unchecked for a long enough period of time. If you go a dermatologist they tell you to stay out of the sun to prevent cancer even though vitamin D deficiency is linked to nineteen different terminal cancers, it doesn’t seem like much of a fair trade. You have vitamins D, A, K and E these nutrients are extremely important as it relates to antioxidant function. In diabetes one of the biggest problems is when blood sugar builds up and it damages proteins in the bloodstream and creates free radical damage. We need these antioxidants to keep the blood thin because if the antioxidant levels are not high enough blood viscosity increases and now we have thicker blood, it doesn’t transverse you can’t get oxygen to the muscle as well you can’t get oxygen to the brain as well and subsequently you won’t be able to deliver nutrition into the tissues. It’s a cascade that begins early on that if left unchecked can turn into thicker blood which increases the risk for stroke and heart attack and it turns into hormonal disruption it turns into muscle weakness and weight gain and we have this perfect storm for a person to become more and more diabetic or more and more metabolically challenged. That’s just vitamins and now we have to look at the minerals as well.
There are a number of different minerals that play a roll in the pathway of regulating blood sugar and generating energy from sugar. If we go back to where we started where that person is eating food and that food turns into glucose and enters the bloodstream, the glucose will tell your pancreas to make insulin, the insulin is the primary hormone that opens the cell so the glucose can get out of the blood into the cell. The center molecule that holds insulin together is zinc. Zinc is essential in order produce insulin, someone who has a zinc deficiency they may still make insulin they may not make it as efficiently and the insulin they do make there’s not enough to go around. The term insulin resistance is really a term that has to do with the kind of insulin a person makes and to the insulin receptor on the surface of the cell.
The shape of the insulin is important, the shape of the key has to match the lock the zinc is important for the shape of that key. The lock itself is made out of chromium and chromium being another mineral it’s nickname is glucose tolerance factor, it’s largely responsible for the keyhole on the surface of the cell. If the person is low in zinc and chromium they develop an insulin resistance and at that point a lot of times doctors will put them on metformin or Glucophage. You might see some additional to those but those are the two most popular prescribed diabetic drugs, the problem with that is these drugs work. They do increase insulin sensitivity but if your on them for any length of time as you start taking them once you get past six months your blocking vitamin B12 and your blocking folate which is vitamin B9 and your blocking a very important critical nutrient for energy production CoQ10. Blocking three nutrients which are responsible for the new replication of DNA and RNA so that our bodies can make new cells and heal but also to generate energy. Again that’s part of the diabetic equation a big part of the problem. If the drug over a period of time, maybe it helps to sensitize the insulin but over time it actually does the opposite so the patient never really gets any better because of the deficiencies incurred by the drug. We now end up with this catch 22 situation where the deficiencies become one of the weight limiting problems for energy development and weight gain and it just spirals from there.
Gluten sensitivity can elevate blood sugar, you take someone who is gluten sensitive and you study them over five or ten years and what do we know about the nutritional status, we know that 67% of patients who are gluten sensitive have a zinc deficiency. That study I’m quoting was a five year study on zinc levels, we know there’s a large percentage of patients with gluten sensitivity that have vitamin A deficiencies, that have D, B1, B7 and chromium deficiencies. It actually has been studied it’s very common to see diabetics with nutritional loss. The other reason it’s very common in diabetics is the nature of the fact they have diabetes, were talking about type 2 were talking about self induced diabetes because at the end of the day were not talking about this disease that just took hold and nothing they didn’t have control over. Were talking about lifestyle choices, not exercising, about eating foods that are very high in calories, very high in sugar and very low in vitamins and minerals. Diabetes is often called the disease where we have starvation in the presence of plenty. Were starving not of calories the calories are coming in through glucose, through sugar, but here’s the thing for every gram of glucose you need your body needs vitamins to process it. Your body needs chromium, zinc, magnesium to process those glucose molecules if the food is low in those nutrients then biochemically you rob your nutrient storage bank to address the food that your eating that’s not nutrient dense. That’s why so many nutritionists and doctors will say you have to eat a lot of fruits and vegetables, organ meats are great for nutrient density, you’ve got to eat those things.
You take the average diabetic patient and what are they eating, their eating box food that are higher in sugar they have added sugar or their very starchy very high in carbohydrates so they break down into sugar very quickly. But at the end of the day in 1943 the U.S. Government banned the sale of grain, you could not sell grain in the U.S. unless you fortified it. Our fortification program where you look at a loaf of bread for example or box of cereal or pasta it will say fortified with because there are a handful of nutrients it has to have added. We have to add vitamins B1, B3, iron and vitamin A, we have to fortify these nutrients into the food it’s illegal to sell it otherwise. Why? That’s the bigger question, people have forgotten the information the reason why during that time vitamin B1 and B3 deficiency were such a big problem in processed food, they were such a problem they were creating diseases. Diseases like berry berry which is congestive heart failure which is right in line with diabetes and cardiovascular disease. They were producing diseases like pallagra which is a vitamin B3 deficiency which basically creates dementia. The late stages of pellagra is Alzheimer’s, is dementia. This also ties into too much sugar increases brain damage and dementia and causes B vitamin deficiencies too much processed food or grain causes B deficiency. So what we have done to solve the problem we added synthetic vitamins to the food it’s not that fortification is a bad idea if we didn’t have it we would have a lot more problems. Then what we do it’s the idea of eating food that isn’t good for us and adding synthetic nutrients to it the fault is that it’s a good idea. What we should really be talking about is how are we going to get high quality food in us not adding synthetic nutrients to food and justify eating garbage because at the end of the day it’s still garbage and it’s still going to have a negative impact on our overall health.
Look at just what a Spectra Cell Lab offers not only do they test the B vitamins they test the zinc and chromium, they test antioxidant status. They test some very important nutrients like vitamin D, A, CoQ10 which metformin causes a deficiency in at the very least a physician would want to monitor if he’s prescribed medication to the patient. Were not monitoring whether or not that medication is inducing a deficiency. Beyond that we have magnesium, there is a process inside the cell when were breaking down the sugar, there is sixteen biochemical steps eight of those steps requires magnesium and magnesium deficiency is extremely rampant in the U.S. because of gut health and sugar. Sugar induces magnesium loss, caffeine induces magnesium loss, how many people drink red bulls and energy drinks on a day to day basis it all starts with low energy. If you just check nutrition responsible for generating energy efficiently we might be able to put down the energy drink and walk away with good energy without the caffeine dependencies.
We would also check chromium, magnesium and zinc but there’s two other parameters on that particular advanced lab test one is glucose insulin interaction, it measures the interaction between glucose and insulin and how their working if their working appropriately or not. It’s a very valid and very viable test to pick up on blood sugar disruptions and dysregulations much sooner than a hemoglobin A1c test might pick up or an insulin test or blood glucose test. The other thing that test has to offer is fructose sensitivity, glucose and fructose are not metabolized in the same way and fructose is just as guilty as generating a diabetic state or metabolic state as glucose they both play a roll in the process. Having that information in front of you as a clinician and able to show it in black and white to your patient these are the things that are wrong, these are the nutrients that you don’t have enough of. We can do a couple things, we can change your diet we can incorporate more of these nutrients through your diet. We can also supplement you with therapeutic doses so that we can overcome your blood sugar disruption now so you get energy and feel better now, you get that one piece that makes everything better beyond supplementation beyond diet is exercise. I’ll go one step further it’s actually maintaining metabolic muscle tissue. Active muscle tissue, I’m not talking about Arnold Schwarzenegger I’m just talking about having good muscle tone the more you have the less insulin resistant you are. Because muscle drinks sugar, drinks glucose very actively very efficiently so the more metabolic tissue you have the much less likely you are to develop diabetes.
Fundamentally our bodies are designed to store, we’ve spent millions of years evolving to store for a rainy day. Fundamentally we live in a world where food is available 24/7 but people don’t realize that availability doesn’t mean we have to eat it 24/7 it’s ok to be hungry, it’s ok to not eat three times a day. If you let your muscle burn through glycogen, if you let your body practice using energy then it gets good at using energy and we don’t become so frail and fragile that our blood sugars don’t get so high and so low that we don’t eat six small meals a day we become very good at extrapolating glucose from our storage and so we don’t require food all the time.
When we talk about patients with gluten issues one thing about gluten sensitivity is gut damage and the fastest way to heal is fasting because you take away food and when you take away food at that point the body has to rely on glucogen stores. The body has to rely on stored energy and that’s a good thing your body needs that practice getting at the stored energy and that’s a good thing your body needs in all things. If you take away it’s ability to do things then it doesn’t have to be good at it anymore it takes it’s resources elsewhere doing other things like storing fat. You can call diabetes a disease but basically it’s an adaption, it’s a persons body adapting to a sedentary and poor food diet. If it didn’t adapt what would happen, they would die. If they didn’t adapt to regulating sugars and being able to handling high blood sugars then they would basically keel over into a coma.
I live by the motto test don’t guess, I’ve had patients who are on these diabetic support products and their well intentioned products but if their not deficient in chromium we don’t have to pump them full of 500ml of chromium or they are deficient in chromium but the product only has 200mcg of chromium and it may have taken 1000mcg to get it corrected. If you don’t give enough to correct a deficiency you can have a patient who is going through this process thinking their doing everything right and they don’t get better then they say this whole functional medicine and nutritional stuff doesn’t work. I didn’t get better when it had nothing to do with functional medicine the fact that it did not work it had to do with the doctor who was prescribing didn’t run the lab and was guessing.
There is value in having a baseline so that you know where that patient is going to be six months from now after we have made some meaningful changes. Insulin is probably the most valuable to me because it shows me just where your at where some doctors will measure the adrenals to show you if the pancreas is in a burn out stage or not. I like to see insulin values under five but even though the range in some labs up to twenty or higher can be normal I don’t find that to be normal. I think if we want to stomp diabetes out we have to keep it under five we have to keep the insulin levels low. The next test is the standard one it’s pure glucose, if you look at the ranges on glucose they’ve changed over the last thirty years. We see some labs the levels go up to 100-110 as part of the normal range for a fasting glucose. Typically doctors will look at the 60-90 range, I would say you need to have that under eighty because we don’t want that much sugar floating around in a fasting state we want your body to be more efficient at getting it out of the blood and into the cell that can give us good information. And of course the hemoglobin A1c which is an average blood sugar count over 3-4 months. These are all great tests for baseline there’s tests like C-peptide and C-reactive protein that measures inflammation, if their inflamed and their diabetic there is a much greater risk of damaging blood flow, proteins, hormones and other things. These are all pretty good markers, for me personally I’ll use it to get a baseline. I don’t find that their essential if I were to say what is the most important that I would look at I certainly would look at insulin and glucose but I would look at micronutrition I would also look at food. That would strike some people as different but the food itself is where it begins and a lot of people have developed gut dysfunction their now reactive they have developed an intestinal permeability a leakage in their GI lining so basically have proteins leaking into their bloodstream that are triggering immune responses and inflammatory responses and it also increases blood sugar.
With inflammation were going to pump out cortisol and that’s going to alter and change the nature of how our blood sugar is controlled and regulated, it’s going to help us retain water and help us gain fat. It’s going to put us in a catabolic state meaning our bodies muscle is going to start breaking down which is the opposite of what we want happen in somebody who has a blood sugar problem. So I would say food and measuring for a food allergy so we can manipulate and change the diet in such a way that’s conducive to reducing the overall inflammatory burden on the patients body so that we could get better blood sugar control.
There is six different ways that we could produce an inflammatory immune response against food, six different ways that are not obvious. There is one way that is obvious the traditional anaphylactic IGE immunoglobulin E response, the one where you would have a reaction and can’t breath like with peanuts. If you have a reaction like that you usually don’t need a doctor to test you, you already figured it out on your own. The other six pathways are called delayed hypersensitivity pathways, we make antibodies like IGG, IGM, IGD and IGA we can create something called an immune complex. We can have direct T-cell responses, T-cells are specialized immune cells so those six different pathways rarely get tested, most of the time I see in my patients is they have had an IGG test done so one of the six pathways tested. The problem is it leads to a false sense of foods, hey I can eat certain foods that maybe I shouldn’t be eating because I’m having different kinds of reactions to them. Those all need to be tested so we can tell that patient for certain. Maybe that reaction your having IGG didn’t pick it up but here it is, it could be something deemed as healthy food but the biochemical uniqueness of the patient says that it isn’t healthy for them. That’s what we want to know, what does their immune system like or dislike that we can alter the diet to the point where we can reduce the inflammation to reduce the inflammatory response so were not driving up sugar all day.
There is food but there is also environmental triggers as well, I don’t call pesticides our food. Mold toxicity in the environment, environmental mold I have seen patients that had diabetes that had mold because they lived in a house that had water damage and were constantly being exposed to mold and microtoxins that were causing inflammation. So we test for those things as well, it’s food it’s environmental immune triggers or immune mediating triggers. It’s heavy metals like mercury, cadmium, arsenic and lead these are all know factors that can displace metals like zinc and magnesium. You could have normal levels of zinc and magnesium but if you have an abundance of mercury that mercury is going to push the magnesium away from the receptor sites it’s not going to allow magnesium to work properly. Identifying heavy metal problems is also very critical so we look at the food, environmental toxins and the heavy metals. The name of the game is a reduction of the inflammation response and this is autoimmunity when we have an over exaggerated inflammatory response for a long enough period of time. The immune system basically goes haywire and it starts to react to everything and we become more and more environmentally allergic. Late or delayed onset of autoimmune diabetes in adults, were saying this is a very big reality. Some researchers make the claim that diabetes in and of itself is autoimmune. Some are now arguing that cardiovascular disease, cardiovascular inflammation is an autoimmune process. Were going to see a lot more light shed on this topic over the next many years as far as the research coming out and teaching us a lot more about the internal workings of how this process goes.
Ultimately we have to look at food, we have to measure all six pathways we can’t just measure one and be comfortable with it. We also have to know about the environment, we have to know about environmental triggers beyond food because you can get a heavy dose of mercury in food like fish but you can also be exposed to it through other mechanisms. We live in an industrialized world where lead, mercury and water runoff and air pollution all these things are potential possibilities. How we can attenuate or ameliorate or reduce the person to the exposure of these things so that were reducing their overall inflammatory burden so that we could better control their blood sugars. The metals test is the ELISA/ACT test, another test is the white blood cell test done with a blood draw.
All should be tested for gluten sensitivity, there are a lot of different studies but there are a couple of cultures that saw that almost developed diabetes overnight the Alaskan Eskimo and the Pema Indian. We saw this happen it was because when the U.S. subsidized their food and what were they subsidizing largely sugar, grain and dairy. If we have knowledge of any type of diabetic triggers we know that those three have the potential to be huge triggers. You have to test for gluten sensitivity, I’m not talking about celiac disease a lot of people get them confused there is also non celiac gluten sensitivity. There is lot’s of ways people can react to gluten it can trigger many different metabolic problems and diabetes is certainly one of them. Getting confirmation that you need to get gluten and grain out of the diet to me the best test that could be done is genetic testing looking genetically to see if the person has the perpensity to behave like a diabetic when exposed to grain. We can measure what’s called HLA-DQ receptors, there is two genes alpha 1 and beta 1 and we measure those, there’s certain patterns that we know are non celiac gluten sensitive patterns. If a person has one of those patterns and they choose to continue to eat gluten then the likelihood their going to develop blood sugar disruption and other issues as related to gluten sensitivities is much higher. Genetic testing doesn’t dictate disease it just dictates the predisposition and likelihood that they will go on to develop the disease so we want to know that as early as possible . If that’s something their bodies not going to mesh well with we can take it away.
Dr. Osborne web page
And a very informative page he recommended glutenfreesociety.org
He also mentioned this site for finding a doctor near you myfunctionalmedicinedoctor.org
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnoses or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M. Scherker medical researcher