My Notes From The Diabetes Summit 2017
Dr. Mark Menolascino – Board Certified Internal Medicine, Board Certified Advanced Hormone Management and Anti-Aging Medicine
web page monoclinic.com
Strategies for Reversing Type 2 Diabetes
I think what we have really found is that it goes beyond just the blood sugar issues with diabetes, that there really is an inflammatory fire that’s sparked by high blood sugar. High blood sugar releases insulin, insulin is the most inflammatory molecule that your body makes, the high blood sugar releasing the high insulin. When those cells see that high sugar for so long they become less and less susceptible to the influence of insulin and you develop insulin resistance. You want to catch it as early as you can and put out the fire before it gets out of control, it’s like a wildfire. What we really see is this chronic high blood sugar with the chronic insulin driving this inflammation creates this cyclical event that breaks down the barriers in the brain. You have heard people talk about leaky gut, that’s the gut lining and how certain foods can cause a permeability of the intestines driving inflammation, which really is the heart of most autoimmune disease. Now we are seeing the same process with the brain, the brain has a blood-brain barrier. We thought our brain was a black box and now our education is so far advanced that the brain has it’s own internal immune system that interacts with the rest of the immune system in the body. As we have learned in functional medicine and integrative medicine the body is a whole unit it all interacts, these interrelationships, this interplay of how it all works together. The fire in the gut drives the fire in the heart that drives the fire in the brain. They are all similar mechanisms and they’re susceptible to the influence of that same high blood sugar and high insulin.
When we were in school they told us the largest organ in the body is the skin, turns out they were wrong. The largest organ in the body is the endothelium, the lining of the blood vessels. Like the brain in the past we thought it was just a pliable tube, now we know it’s it’s own organisms, it’s own factory. It makes chemicals that are unique to it and it responds in unique ways to other challenges, particularly high blood sugar. I feel insulin resistance is a low level autoimmune disease, it’s a reaction against it. We know that type 1 diabetes, with the insulin dependent that happens younger in age, is a failure of the pancreas and it looks like the same autoimmune attack against the pancreatic cells. We are now seeing adults that are developing this, and what they’re doing is they’re developing autoantibodies later in life that have the same effect as this type 1 diabetes that happens in younger people. We see the same thing in the brain.
There is some work at Cyrex looking at more than just gluten. I spoke for Cyrex at the anti-aging conference and it was called the neurotoxic effects of gluten. We saw slide after slide of multiple sclerosis patients and their brain MRI’s with these plaques. They had symptoms of multiple sclerosis, they had their MRI findings of it, but it turned out these plaques were combinations of autoantibodies to the gluten. When they stopped gluten their symptoms went completely away in people diagnosed by good neurologists with multiple sclerosis. The plaques didn’t go away, which I find fascinating, so the damage can be done. What they found is when they examined 200 other foods that there were 25 foods that could cause autoantibodies to the brain tissue and cerebellum, which is the bottom part of the brain that is most effected.
We know there is good science out there showing these mechanisms related and that microenvironment of the blood cells in the brain has a little cell called microglia. They are little defenders of the brains inflammation and immune system and there are many things that can activate that. Whether they be pathogens like candida, like bacteria, like viruses such as Epstein Barr or Lyme disease. Or whether they’re internal things being driven by insulin response that is out of control. There is such an intimate relationship of all these different systems I think we’re just finding out where these cues are.
When I think about high glycemic foods, processed food, starches for some people, or other food sensitivities, it’s just like pouring gas on the fire. The first thing you can do to help yourself not develop diabetes or reverse it is to really look at your nutritional status. I think the way we’re doing that with the ADA and the other diabetes associations is they’re a little bit behind where we are in functional medicine. We see people who come in on 2-3 diabetes medicines, they don’t leave on them. Their doctors call me and say their A1c and their sugars are better and they’re off their medications, how did you do it? I tell them and they say that will never work, or nutrition really doesn’t matter, or that’s just that one person. But we are seeing this, it’s not a one size fits all, that’s the beauty of functional medicine it’s a personalized, precision, individualized approach. That’s what really works, that’s what our clients are really looking for. This is our own functional medicine wildfire that is going to be spreading, more and more doctors are getting certified like we are and it’s really exciting to see, it’s really exciting to be in medicine right now.
What we were taught in med school is to do the glucose challenge test where you come in fasting and do your fasting blood sugar. You drink 70 grams of that nasty orange liquid, then we check your blood sugar every thirty minutes for two hours. What we do is we check the insulin as well as the blood sugar. What we find is that the blood sugar may not really rise that much but the insulin will have an incredible spike. A lot of people have true insulin resistance but never show up on the traditional testing. There is a real question about the hemoglobin A1c that’s really telling us our best benchmark and how to identify these people. The glucose insulin challenge is really the way you find these people and insulin being such an inflammatory molecule. What we’re finding with cognitive impairment it’s based on the work of Dr. Dale Bredesen of the Buck Institute who has really thrown Alzheimer’s on it’s head.
When I was in medical school we had a functional medicine team of where a psychiatrist, a geriatrician, an internist that specializes in older patients, a pharmachologist, nutritionist, and social worker would all meet with the family of a client that had Alzheimer’s. At the end of the day we would all sit down as a team and develop a care plan, we just didn’t have the knowledge back in the 90s of how to do this. Now with all the work of the people who are in this type of medicine we now know it’s a multifaceted approach. That’s the beauty of the functional medicine approach you look at all these individual factors. It’s based on their genetics because some people just process nutrition differently, some people’s nutrient needs are much higher or much lower than others. These special parts of the genes called the snips are telling us who are the canaries in the coal mine, who’s going to be the most susceptible to gluten based foods, high glycemic foods, it’s not a one size fits all.
When you have the insulin driving this process and the inflammatory potential that you have with the insulin levels you have these continuous rushes on inflammatory particles that basically spread this fire in the brain. You then get downstream effects of hormone imbalances, of nutrient deficiencies, of absorption issues, so you basically unhinge the wagon, Once that starts it’s like a wildfire out of control and continue to be developed. But each person that has dementia got there from a different spot. What I think we’re going to find is the single-model therapy approach for Alzheimer’s is completely wrong, it’s not an acetylcholine problem like our medications are trying to effect, it’s a multi-systemic functional medicine problem and everybody’s path to get there is different. It could be mold toxicity releasing biotoxins, it could be Lyme disease, it could even be for most people this inflammation driven by this high insulin because the high body fat that Americans have, America is an obese nation.
The maps we see in our conferences, what happened from 1970 to 2015, are so scary from having no states with a majority obese to all the states in the country being obese. All the people don’t want the external fat but it’s the internal fat, what we call the visceral fat, I use the term it’s the hot fat. That’s the fat who the doctor that cares about you I don’t want you to have. We have a machine that looks at the external fat and the internal fat so you can measure who’s got this. It’s developing another problem called fatty liver, there will be more liver transplants in five years from fatty liver than there will be from Hepatitis C, that’s a scary number. The internal body fat driving the fatty liver, driving the insulin resistance, they are all pieces of this fire that are going to end up as cognitive decline. It’s really driving this multifactorial, it’s not just your genes. That’s one thing I like to share with my patients, it’s the epigenetics, it’s what you bathe over your genes.
I used to tell people that food is medicine now I tell them food is information, the food that you bathe over your genes can turn on good ones or turn on bad ones. You’re not the genetic destiny of your mom and dad or your grandma and grandpa, you are you’re genetic destiny of what you do to your own genes. That’s a very empowering message to hear they’re not just destined to be obese, diabetic, and have a heart attack at 60 like their parents may have. We can now change these trajectories, and if you’re changing the trajectories for diabetes you’re changing it for heart disease and you’re changing it for Alzheimer’s. They are all the same thing, fire in the body, fire in the brain, fire in the heart, fire in the gut. It’s an exciting time working with clients and see them shift, in other doctors offices people just get more and more medications but they don’t really change their quality of life. What we see is people come in and they may have come in for irritable bowel, maybe for arthritis, might have come for diabetes. But as we move them through the program their diabetes is better but so is their sleep, so is their love life, so is their energy, their joint pain, all these other things they didn’t expect to happen. I love this, my staff is happy, we have a different relationship with our patients.
It doesn’t matter what walks in the door we have programs and functional medicine to fix them. This wave of chronic illness that’s led by obesity and diabetes is crushing our healthcare system. If we could shift just that one piece we’ll also shift heart disease, Alzheimer’s, the burden of autoimmune disease, it’s all going to come back down. People are going to have longer life, better quality of life, a more fulfilling life, and I really see the light on the horizon, this is happening. Our job as functional medicine doctors is to provide information to empower our clients with knowledge to help them change their behaviors based on their belief system. If we give them that information and those tools then help guide them along to what they’re looking for. They are looking for higher quality of life, more energy, a better love life, they’re looking for all these things and we can show them the path. It’s exciting to see them become empowered and to do so well.
I encourage people to look at their concerns about family members that have Alzheimer’s, heart disease or diabetes not as their future, but as an opportunity for them to head it off. These processes start decades, you don’t just wake up one day and have dementia, this is a process that happens over 10, 15, 20 years. We used to do a test called APOE, and there is different sub-types and one is 60% more likely to develop Alzheimer’s. But you can manipulate the outcome of that gene based on what you do with it. If your parent has Alzheimer’s and you eat the way they do, exercise the way they do, have a lifestyle similar to theirs, you will probably get it too. But if you have their genes you could modulate those based on your lifestyle choices. It’s really coming up with this personalized approach, it’s looking at your hormones. We’re giving 70 year old women estrogen to optimize their hormones for their brain, that was unheard of five years ago.
One of the first patients I was able to turn over and reverse her Alzheimer’s came to see me, 70 years old, this was a decade ago. He was on several medications that we know poison the mitochondria, the energy powerhouses of the cells, he had the genetic pattern so his physicians felt he was doomed to have Alzheimer’s. He tried the medications, per his and his wife’s report they didn’t really help much, he was basically left out to dry. We took him off his medications, optimized his hormones, we fixed his leaky gut, we looked at his copper and zinc ratios, looked at his heavy metals. He was heavy metal toxic to cadmium because his wife smoked and he got the cadmium smoke from it. He was heavy metal toxic in lead, he grew up in an area that’s known to have high lead. There was heavy metal issues, there was mineral deficiencies, there was hormone imbalances. We did put him on testosterone to optimize his testosterone levels, optimize his adrenal function. His thyroid was not abnormal but it wasn’t optimal so we actually put him on low-dose thyroid medication as well. You kind of do the kitchen sink all at once, you have to patch all these holes in the roof otherwise you’re not going to get there. It’s a synergy, not everybody has to do all thirty things, there is going to be some people who benefit more from one area and more from another.
That’s where this new area of genetics is really helpful for us because we can see in your genetic SNPs, where the epigenetic sweet spots are. Where we can make some of these small modulations and get a huge downstream benefit, or other things you want to be super careful of because those can be traps that we could send somebody down and sabotage their progress. This isn’t rocket science it’s just stepping back and looking at all the tools we have and applying them all at once. That’s where I think again the mono-therapy of Alzheimer’s is doomed to fail. I think what we’re going to find ten years from now is that this is not one disease. It’s a multifactorial end point of all these different toxicities and deficiencies causing these other downstream problems. We think everything’s related to the gut and many things are. We think many things are related to the mitochondria, which are the energy powerhouse of the cells, many things are.
There are some sweet spots that you can do but at the end of the day it’s going to come down to the individualization of each protocol for each person. The other key is having a support system to help. We actually won a research award for that first case, evidence based supplements course I encourage every physician to go to. I’m not a supplement guy, I want food to be your medicine, kitchen to be your pharmacy, lifestyle to be your doctor. But when you’re addressing these illnesses there are sweet spots that target high quality nutraceuticals make a huge difference. My other message would be look at your vitamins and turn them over, if they’re is more things in the other ingredients than there are in the ingredients. Or if there is words in the other ingredients that you cannot pronounce, you should not be taking that vitamin. A lot of people are taking toxic vitamins, they’re using rancid fish oil, you have to use targeted nutraceuticals but use companies that use the highest quality, it makes a huge difference in your safety and in the efficacy of it.
If there is one thing that you could do is look at what you’re eating, you vote everyday with your fork about what you want food in America to be. It’s actually cheaper to eat healthy than it is to eat fast food, it’s just convenient to eat fast food. If you simply look and go back to kind of a Mediterranean based diet, or really eating just whole food, that’s your best way to just knock inflammation down in your body. You’ve got to eat anyway, just spend a little time learning about nutrition, work with somebody who understands nutrition. If your doctor doesn’t know nutrition, we were taught in school – we got 20 minutes of nutrition and they disguise it as scurvy and rickets so we didn’t get nutrition. They are starting now to incorporate it and we’re getting physicians who are finding it on their own. I challenge you to challenge your doctor to know nutrition or have someone on their staff.
You have to see my nutritionist if you want to see me, I will not let you see me without seeing my nutritionist. That’s how important that I think that is. Those are the health coaches, and functional medicine has a health coaching academy that’s turning out these fantastic health coaches. I think at the end of the day it’s going to be these health coaches that do the most help rather than the doctor, we’re just going to make the big decisions. But helping people be successful it’s the nutritionists, it’s the health coaches. I don’t really care what your degree is if you’re part of my health care team we’re all equal. We all have a power to help share information to shift these people, but it’s really at the end of the day all about what you eat. And coming up with a plan to put that fire out starts with your nutritional choices everyday. If you don’t do those first it doesn’t matter how many pills or supplements you take you’re not going to get anywhere, you’ve got to start with whole-based nutrition.
Watch the food documentaries, knives over forks, food inc., it really talks about where some of those sweet spots you can do. The other thing is Google glycemic index and learn about the foods that when you eat them they skyrocket your sugar. The glycemic index is a little misunderstood in that it’s got the sugar load and the insulin load that you have, but it’s not just the index of the food it’s how much of that food you eat. For example, carrots have a high glycemic index but you typically don’t eat a bushel of carrots. So it depends on how much of what you eat not just the index. That’s one great place to start to say these glycemic foods that are really high and I eat all the time, I need to substitute for them. The other thing I tell people is eat six different colors a day. Because if you’re eating different colors like a red pepper, green lettuce, orange carrot, yellow banana, you’re getting some of those key nutrients. The amount of nutrient deficiency that we have in America is shocking, and the government even admits this. I think it’s up to 59% of Americans are deficient in magnesium, in a base core nutrient that’s crucial for insulin processing and blood sugar reduction, it’s simple magnesium. I’m not saying rush out and buy magnesium, Google magnesium foods on the internet, find out which ones are there, see which ones you’re eating. Which ones you could eat and let food be your medicine to raise those levels up rather than relying on a pill.
We are starting a physician training program in reversing cognitive decline. We have been reversing it in individual patients and we will still be doing that. What I really want to do is teach doctors how to do that so he can go back to his community and do that. We are going to give the program away so they can go back and teach you.
We have talked a lot about the gut and if you have heartburn, you get bloated after you eat, you have constipation, alternate diarrhea, or you just feel you have a digestive problem, you have inflammation. It’s shocking how most people. because they mention their digestive problems to doctors and got blown off, they don’t bring that up in a discussion. Like my stomach has always been that way, or yea I had irritable bowel as a child and I was told there was nothing you could do about it. Well, irritable bowel doesn’t exist, irritable bowel is a symptom of digestive dysfunction. You have to figure out why the digestive dysfunction is there. Again a lot of it has to do with food.
We talked about the glycemic index. You can look at your hands, if you’ve got red areas around the cuticles that’s a sign of inflammation. If you’ve got little bumps on the back of your arms, if your face is really ruddy and flushed. I can walk through the grocery store and see who’s got inflammation. If you have joint pain you probably have inflammation, now if you broke your ankle as a kid maybe that’s not so much. But two people with the same MRI’s of their knee one can hurt one doesn’t, it’s the inflammation wrapped around the physical problem. Look for these pains, the oral cavity is the other area, really keep good oral health. You talk about the microbiome of the gut, we also talk about the oral biome, the sinus biome. If you’ve got chronic sinus issues, congested all the time, you get itchy eyes, you’re an allergy sufferer, all of those things are signs that you’re inflamed. You want to look and take the natural tools you can to find ways to reduce that inflammation. If your knees inflamed, your guts inflamed, your hearts inflamed, and your brains inflamed. It’s just not going to show up until 10-20 years later.
One of the tests that I really like is the food sensitivity test. It’s an IGG food sensitivity test you can do with a simple prick of your finger. It shows you 96 of the most common foods that are reeking havoc in your gut and causing inflammation and driving this leaky gut process. Cyrex does that test as well. Another level of that is the antibodies your body is making in response to that leaky gut, those are the tests that I want to find. By the time someone is diagnosed with Rheumatoid Arthritis this process has been going on for probably a decade. In fact there is an antibody called the CCP antibody that you can order and find those people who are going to have Rheumatoid Arthritis five years from now. Before they show x-ray changes, before they have the joint pain changes, this process is already going on. I don’t do as much testing as I used to because I can tell from your story where the sweet spot is. A lot of times we get the gut healthy, we get the nutrition supported. Then we go looking at their genetics and looking at their other deficiencies, instead of doing a shotgun lab panel we do the easy stuff first. Once we get people to feel a little bit better then they’re more motivated to do the hard work.
If someone comes to see me and I tell them to go dairy and gluten free, 90% of them probably can’t figure out how to do that. If we get them started and they see some benefit by doing a protein shake in the morning, just stop eating bread and you drop five pounds. Your sleeps better and your guts improved just by doing that, then you might want to be more supportive to doing the harder work. Going gluten free is not for everybody, but there’s a high rate of it and I like people to just start with bread because a slice of bread is equal to a can of soda pop. The sugar load of a slice of bread, whether it’s twelve grain whole wheat or white wonder bread, your body sees it like sugar. The same thing with alcohol, a glass of wine is a glass of sugar. Those are two things you can control and moderate and really get a pretty easy sweet spot with that. For my clients when they get a little bit of benefit then they see there is some wisdom in lifestyle changes so we don’t try to throw the whole thing at them at once it’s a step wise approach.
The beauty of functional medicine is the hard part of functional medicine is everybody’s unique and they all get an individual plan. It’s not a cookie cutter one size fits all. That’s why it works because it takes into people’s unique habits, their unique desires, and their unique genetics, based on all of this to get started. A lot of people are doing the 23 and me genetic testing and there are a lot of functional medicine doctors that are now knowing how to read that. We have the rosetta stone to figure out who are people who can’t detoxify, who are people who have been exposed to mold and can never clear it. Who are people who are going to be susceptible to the damaging effects of inflammation or of gluten. The genetics have a code built into them but you have to understand how to read it so it doesn’t help you just to do the testing. You have to work with someone who understands how to interpret that testing and where it fits, then customize a unique program for you.
I have a new book coming out titled Fire on the Brain, the concept of brain inflammation, blood sugar, and the whole connection there with metabolic health. Explaining my protocol and programs and where you should start and do first.
The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment from a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems you may be experiencing.
M. Scherker medical researcher