Dr. Laura: How Sugar Ages the Brain

Vulnerable populations with long term unmanaged blood sugar levels are subject to brain atrophy (shrinkage) and accelerated brain changes including memory loss and cognitive decline.

Memory Lapses?

Vulnerable populations with long term unmanaged blood sugar levels are subject to accelerated brain changes including memory loss and cognitive decline. 

Who’s most at risk?

Most at risk are those with Diabetes type I and II monitor sugar regularly and those with metabolic syndrome or cardiovascular disease. 

But that’s not all. 

Anyone with long term fluctuating blood sugar levels could be at risk for cognitive decline. So those with chronic stress are also at risk. Stress elevates cortisol, which subsequently activates sugar into the blood stream. This is really helpful when we need the energy to physically run from the tiger.  However, in our day in age, the tiger is more likely to be the boss, the lack of sleep, the poor diet, or the overscheduled.  Stress, namely long-term cortisol release, affects the microbiome. Certain drugs like antibiotics and oral birth control pills can also change the microbiome. Shifts in populations of gut bacteria can evidently impact blood glucose regulation. Overgrowth of candida can make us crave sugars and leave us in a state of flux or what we have now termed “hangry”. 

If you are the hangry type, you likely have issues with blood sugar. 

A state of blood sugar surges and crashes overtime will lead to unfortunate hippocampus affects, namely sugar induced shrinkage and memory challenges. 

Those at risk:

  • long term fluctuating blood sugar levels
  • history of oral birth control use
  • history of antibiotic use
  • diabetic patients on metformin
  • elevated cortisol
  • chronic stress
  • poor diet
  • lack of moderate regular exercise
  • disrupted sleep patterns

What’s a healthy blood sugar level?

Guidelines for healthy levels are subject to some interpretation, however from a functional medicine point of view, HbA1c should be between 4.6 and 5.3% and fasting blood sugar levels are healthiest around 4-6mmol/L. Note that those with red blood cell disease like sickle cell anemia, which change the shape of the blood cell, HbA1c is not a reliable marker and other markers like triglycerides, and fasting blood sugar levels must be taken into account. 

Protect your brain

Protect memory and cognition with adequate blood supply, high levels ofanthocyanins, appropriate levels of B vitamins, omega-3 fatty acids and a diet low in sugar and high in fibre, protein and healthy fats. Caution with drugs like metformin, which help regulate blood sugar in diabetics and is associated with cognitive decline. Apparently, this could be due to a number of factors, and not just the drug directly; it is therefore important to monitor B2 (riboflavin), B6, B12 when on metformin. 

It is important to include in the diet:

  • high levels of anthocyanins
  • plant powers found in dark blue and purple fruits and vegetables
  • consistent intake of B-vitamins 
  • egg yolks, red meat, liver, clams, mussels, avocados and dark leafy greens
  • daily dose of omega-3 essential fatty acids
  • cold water fatty fish like salmon and sardines
  • flax, hemp and walnut

Is diet alone enough?

Is diet enough to keep up with the demands of cognitive decline? It is difficult to know as diets of many individuals need to be followed for years and it is difficult to control what people eat on a daily basis for any length of time. First and fore most get what you can from the diet, yes, this is critical as the body knows best how to get nutrients from food. Insulin sensitivity is an important factor in blood glucose regulation and a short-term keto diet and or fasting is proven to be effective method to reset it. 

Reduce the risk factors as indicated above and get help to re-set the microbiome. That means create a sleep routine where you go to bed and wake up at the same time every night. Move your body every day for about 30 minutes. It means to have space in the day that is not filled with tasks and demands. Take appropriate supplements where diet falls short or medications deplete. 

Memory and cognition decline over time. It doesn’t happen overnight. So too should your changes and lifestyle reflect a long-term plan. If you feel you need help, Naturopathic Doctors are trained in lifestyle and laboratory analysis, diet, nutrition and nutraceuticals. 

Dr. Laura M. Brown, ND is a registered naturopathic doctor with a functional medicine approach.  She has advanced training in pharmaceuticals, is a certified HeartMath Practitioner and a Certified Gluten Free Practitioner  and holds the designation of ADAPT Trained Practitioner from Kresser Institute, the only functional medicine and ancestral health training company.

References:

Cui X, Abduljalil A, Manor BD, Peng CK, Novak V. Multi-scale glycemic variability: a link to gray matter atrophy and cognitive decline in type 2 diabetes. PLoS One. 2014;9(1):e86284. Published 2014 Jan 24. doi:10.1371/journal.pone.0086284

Zhao X, Han Q, Lv Y, Sun L, Gang X, Wang G. Biomarkers for cognitive decline in patients with diabetes mellitus: evidence from clinical studies. Oncotarget. 2017;9(7):7710–7726. Published 2017 Dec 14. doi:10.18632/oncotarget.23284

Dr. Laura: Is Your Thyroid Tired ?

Perhaps your thyroid needs a check-up? It does if you feel sluggish, tired, constipated, have difficult concentration, and are a wee bit depressed.

Subclinical hypothyroidism is when a patient with sluggish digestion, cognition, fatigue and weight issues has a high TSH but normal T4. It is important to look at the reasons for the symptoms, which could have multiple causes, before reaching for the thyroid hormone replacement drug.

Don’t let the sunset on your thyroid…

What nutrients help the thyroid?

Nutrition is a factor. Consider levels of zinc, iodine, selenium and iron as they all play a role in thyroid function. B12 is also an important one to look at and easy to run the labs to determine its status.  Also the health of the gut microbiome and liver needs to be healthy as a large amount of the inactive T4 converts to the active T3 thyroid hormone in the liver and the gut. So many people have issues with the balance in their microbiome.  

Does stress play a role?

Another area of thyroid health to consider is the stress axis. This involves the hypothalamus, pituitary and adrenal, or HPA. Chronic long term stress can make it difficult for optimal thyroid function. In addition to mineral level attention, it is highly important to support the adrenals and provide opportunities for stress management.  

Are there natural thyroid medications?

Finally, there are other options to synthetic thyroid. Natural desiccated thyroid (NDT) may be something to consider if diet and lifestyle changes don’t break through the fog. NDT provides both T4 and T3, which is good if there is an issue with conversion.

How can a naturopathic doctor help?

Naturopathic doctors are medical trained and naturally focussed. They can run labs for the nutrient levels, thyroid stimulating hormone (TSH), T4, T3, and any antibodies to help rule out autoimmune thyroid disease. This helps determine what nutrients might be missing and what foods or nutraceutical dose to suggest and for how long. Naturopathic doctors with education in pharmaceuticals are able to prescribe natural desiccated thyroid. They are also very good at stress management and adrenal (HPA-axis) support with both nutrition, lifestyle and stress management programs.

Dr. Laura M. Brown, ND is a board certified naturopathic doctor with advanced training in pharmaceuticals, functional medicine and stress management. She is a Heart Math Certified Practitioner, a graduate of the Kresser Institute’s Adapt Level 1 functional medicine training and is a Certified Gluten Practitioner.

Dr. Laura: Is it aging or low B12?

B12 deficiency has been estimated to affect about 40% of people over 60 years of age, and about 40% of the general population are on the lower end of normal.

Vitamin B12 deficiency can look like the signs and symptoms of diseases that are commonly associated with aging such as Alzheimer’s, dementia, cognitive disorders, multiple sclerosis, Parkinson’s, and other neurological problems; depression and anxiety; cardiovascular disease; cancer; and low libido. If someone you love has these symptoms, best to get their B12 levels checked and supplement if help reduce the symptoms.

Supplementing with an active form of B12 can help reduce inflammation, which has improved symptoms of arthritis and eczema.

Vitamin B12 works with folate to make DNA, red blood cells and the insulating sheath around the nerves to help with nerve signalling. This is why when I inject B12, I always include folate with it.

Causes/Risks of B12 deficiency

  • Vegan/vegetarianism
  • Intestinal malabsorption due to low stomach acid
  • Celiac disease
  • Crohn’s disease
  • Pernicious anemia (an autoimmune condition affecting our ability to absorb B12)
  •  Atrophic gastritis (usually H. pylori infection in the elderly)
  • Long term use of Proton Pump Inhibitors (PPI’s)
  • People on Metformin therapy

If someone you know or love fall into any of these categories, best they get tested even if they don’t have symptoms, as deficiency can start before the symptoms show up.

Symptoms of B12 Deficiency

  • not much if  it’s mild
  • weakness
  • fatigue
  • strange sensations
  • numbness, or tingling in hands, legs, or feet
  • difficulty walking such as staggering or balance problems
  • anemia
  • a swollen, inflamed tongue
  • yellow skin
  • jaundice
  • difficulty thinking and reasoning
  • memory loss
  • paranoia or hallucinations

Testing for B12

It is easy to run a B12 test, however there are other blood and urine markers that can provide a more complete picture, such as methylmalonic acid (MMA) and homocysteine. Homocysteine may be more sensitive and accurate for detecting the early stages of B12 deficiency. When I run tests, I look at things from a functional medicine perspective and this may involve the more complete profile.

If there is an absorption issue suspected, we need to identify and correct that, if possible. Further testing and treatment may be required to do that.

The results of the tests are also interpreted differently when you come to see me. I look at things from a functional range – your optimum level of performance- not the point at which you have disease. The conventional medical system in North America regard a low B12 to be below 200 pg/mL. This is the point where irreversible neurological damage can happen. I prefer to go at the guidelines set out by Europe and Japan – somewhere over 550 pg/mL.

Supplementing

Best to get B12 from animal based sources – strongest providers are the organ meats (liver, kidney) and seafood like oysters and clams. To get ahead quickly or to supplement a vegan or vegetarian diet, you will need activated B12, so hydroxy or methyl based cobalamin are the best. If there is intestinal absorption issues, then you’ll need a pill to dissolve under the tongue or an injection to provide the boost. What I carry in the clinic is an activated form of B12/B complex so it absorbs easily and we see good results on the before and after blood work, or we can go for the injection – usually weekly for a month and then once a month for a few months. Then we re-test.

Dr. Laura M. Brown ND is a Naturopathic Doctor with a Functional Medicine approach. She is a Certified Gluten Practitioner, A HeartMath Certified Practitioner and is engaged in ongoing education with the Kresser Institute of Functional Medicine.

Dr. Laura: Surprising Number of Conditions Linked to Celiac Disease

I just received this post… hot off the press from the World Congress of Gastroenterology. We learn about all the conditions that are linked to Celiac disease. This means if you have migraines or anxiety attacks, more people with Celiac have them than not. Or, if you have a specific type of rash called dermatitis herpatiformis, you are pretty well guaranteed to have celiac. Have a look at the chart below and see if you have any of the following conditions and then look at the odds ratio that you may have Celiac Disease.

Celiac disease is an autoimmune condition related to the ingestion of gluten, or wheat. Wheat has over 100 proteins in it and gluten and gliadin are just two of these proteins. Your body can launch an immune attack to any of these proteins, then these could cross react with tissues in your body including your brain, liver, pancreas, skin muscles, or as in Celiac, your small intestinal villi. If your villi are damaged, then you are not absorbing vitamins, minerals and nutrients. So this can additionally lead to things like B12 deficiency (depression, brain fog, neuropathy) iron deficiency (dizzy, weak, pale), or osteoporosis.

Conventional medical testing will look at 2 markers for these proteins immune reactions. Functional Medical tests that I run will cover 24 markers, including these 2 from conventional means. You have to pay for both tests out of pocket, so I figure you may as well run the more complete test to get the bigger picture of what’s going on in your body. The broader testing means we can catch wheat related diseases – non-celiac gluten related disorders like cerebellar ataxia (problems with balance and walking) or wheat addiction (it’s like opioid addiction!) or tell it if is reacting with you muscles (polymyalgia?) or skin.

Table 1. Prevalence of Diagnoses in People With and Without Celiac Disease (P < .0001 for All)

Diagnosis With Celiac Disease, % Without Celiac Disease, % Odds Ratio
Migraine 18.6 4.1 5.5
Anxiety disorder 25.9 8.7 4.0
Arthritis 28.9 8.4 4.9
Dermatitis herpetiformis 1.3 0.0 4563.5
Liver disease 23.2 4.2 7.1
Gastroesophageal reflux disease 36.8 13.0 4.5
Eosinophilic esophagitis 0.6 0.1 8.8
Atrophic gastritis 3.9 0.1 8.0
Glossitis 0.4 0.1 4.4
Pancreatitis 15.8 0.7 25.0
Disorder of the pancreas 17.2 1.1 19.0
Cerebellar ataxia 0.1 0.0 4.1
Autism 4.0 0.2 19.9
Colitis 25.9 4.2 8.4
Turner syndrome 0.1 0 17.8
Down syndrome 0.6 0.1 8.1
Common variable immunodeficiency 0.2 0.0 10.2

Do you need more vitamins?

What drug should you avoid taking with vitamin C? Why could your feet be tingling? Long term use of Metamucil make you deficient in a what B vitamin? Easy bruising and bleeding could be a sign of what vitamin deficiency?  What vitamin is made by bacteria?

This is Part 2 of 2 on vitamin deficiency. It covers information on vitamins B5, B6, B12, C, D,E, & K.

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Vitamin B5: Pantothenic acid (B5) is used in metabolic cycles is key to the body’s production of energy, cholesterol, heme and acetylcholine. Cholesterol is used as the back bone of many hormones. Heme is used to carry oxygen in your blood. Acetylcholine is controls involuntary functions mediated by the activity of smooth muscle fibers, cardiac muscle fibers, and glands.

Some body signals that you are low in B5: burning, numbness or tingling in the feet, muscle weakness, swollen tongue (glossitis), cracks at the corner of your mouth (chilosis), recurrent upper respiratory tract infections (colds), fatigue, postural hypotension, hypochlohydria, GERD/heartburn, and depression.

Sources of B5:  whole grains, broccoli, kale, cabbage family of vegetables, mushrooms, legumes & lentils, avocado, eggs, milk, poultry and organ meats.

Vitamin B6 (Pyridoxine/pyridoxyl/pyridoxamine) is involved in over 50 enzymatic reactions and potentially effects the function of cardiovascular, skin health, blood production, nerve function, healthy pregnancy, blood sugar regulation and cognitive function. Signs of deficiency include anxiety, depression, insomnia, irritability, confusion, abdominal pain, weakness, seizures, anemia, and poor immune function. There is even a rare form of B6 deficient epilepsy.

B6 requirements increase with diseases that affect absorption such as Celiac disease. The increased prevalence of hydrazine and hydrazide compounds as found in aerospace fuels, anti-toxicants in the petroleum industry, plating materials in metal manufacturing and ripening agents used on plants. B6-zapping hydrazine is also found in tobacco smoke, tartrazine (FD &C yellow food dyes). There are numerous drugs that deplete B6 and lead to common sides effects such as neuralgias, depression and anxiety.  Those with Parkinson’s disease should consult a medical expert before supplementing with B6 as it can interfere with L-dopa when taken without carbidopa.

Food sources of B6 include potatoes, bananas, meat, poultry, fish and whole grains.

Vitamin B12: Methyl or Hydroxyl cobalamin. Measured via B12 serum levels. Falsely elevated B12 levels may exist in those with renal failure or hepatitis. Those with vegan diets are at increased risk of deficiency as major food sources are animal based.

Pernicious anemia is the result of loss of intrinsic factor, a protein that is excreted by the stomach and helps B12 absorption in the small intestine. If the stomach has low acidity as in long term use of proton pump inhibitors (a lot of medications ending in “-prazole”, presence of H.pylori, aging or damaged parietal cells as in autoimmune disease, or the small intestine mucosa is damaged as in Celiac or Crohn’s disease, B12 absorption will be reduced. Additionally those on long term use of psyllium (Metamucil) will be at increased risk of B12 deficiency. Large amounts of orally dosed B12 may help compensate by allowing for absorption by diffusion. Intramuscular injection (IM) of B12 (available with Dr. Laura) by passing the need for intrinsic factor. IM or intravenous B12 is also more helpful than oral supplementation for those with a defect in the transportation system of B12 to the brain or a an accelerated breakdown of B12 in the brain tissue. Signs of B12 dependency are dementia, depression, headaches, insomnia or chronic fatigue.

Vitamin C (ascorbic acid) is important in immune function, collagen formation (for skin and connective tissue), neurotransmitter formation, plays a role in fighting viruses and bacteria and is a key anti-oxidant. Scurvy is the severe form of vitamin C deficiency. Fatigue, depression and anxiety of health are acute signs preceding the diagnosis of scurvy. Signs are bleeding abnormalities due to poor connective tissue formation and possible vitamin C deficiency include bleeding nose, easy bruising, bleeding gums, bone pain, osteoporosis, arthralgias (pain stiffness and joint swelling), myalgias (muscle aches and pains), edema (swelling), and symptoms of suggestive of cardiovascular disease or mimicking peripheral vasculitis, or venus thrombosis.

Dose limiting symptoms of vitamin C are diarrhea and cramping.  Vitamin C increases the absorption of non-heme iron this is good for those with low levels of iron/anemia. Vitamin C also seems to help the absorption of aluminum, which isn’t so good as it builds up in the bone, brain and liver and may contribute to the development of osteoporosis and Alzheimer’s disease. Avoid taking vitamin C at the same time as antacids, or aluminum hydroxide compounds. Chewable vitamin C may erode your dental enamel (it is an acid). Vitamin C supplementation can help or hinder the function of various medications; check with your medical practitioner for details.

Good sources of vitamin C include bell peppers, citrus fruits, cantaloupe, broccoli, Brussels sprouts, cauliflower, potatoes. Vitamin C is lost in high temperature and prolonged cooking.

 Vitamin D (cholecalciferol) The body makes vitamin D when the skin is exposed to sunshine or ultraviolet light. About 20 min of unprotected exposure mid day in the summer months in Ontario will produce about 1000IU of vitamin D. Small amounts may be found in food sources such as fish, egg yolk, beef liver, however, when sunlight is inadequate (no exposure or seasonal variance), supplementation is essential.

Vitamin D helps the body absorb calcium and phosphorous, builds bone mineral matrix, helps the nerves and muscles function, boosts the immune system, and modulates autoimmune diseases. When the supplemental D3 taken with K2, vitamin D helps get calcium out of the blood stream and into the bones. Vitamin D deficiency can be suspect in multiple sclerosis, cancer, pancreatic deficiency, Crohn’s, Colitis, fibromyalgia, chronic fatigue, chronic low back pain, or severe muscle weakness. You may purchase D3+K2 drops at Forward Health.

Vitamin E: There are 8 different kinds of vitamin E – each a different type of tocopherol. Vitamin E is known as an antioxidant and the most potent, bioavailable form is alpha-tocopherol. When supplementing it is best to have a mixed or blend of tocopherols. Vitamin E is also involved in anticoagulation (inhibits platelet aggregation), is anti-inflammatory and stabilizes the cell membrane. Those with fat malabsorption issues at risk for deficiency. Vitamin E is also depleted in those with a high consumption of fatty foods, as thermally oxidized vegetable oil depletes vitamin E status. Good food sources of vitamin E include almond oil, wheat germ oil, nuts and seeds, whole grains, egg yolks and leafy green vegetables.

Vitamin K: There are actually four different kinds of Vitamin K. Vitamin K1 is what is often tracked so closely for those on warfarin because warfarin is an anticoagulant and affects the INR – the measurement we use to factor coagulation, or thickening of blood. Vitamin K1 is found in lots of leafy greens. K1 is also given to newborns to help prevent hemorrhage; a newborns’ intestinal tract is not yet making its own Vitamin K. K2 is made by some bacteria in our gastrointestinal tract, and by bacteria in some foods, like brie cheese. K2 helps Vitamin D3 get Calcium into the bones, so is useful in those suffering with osteoporosis or steroid induced bone loss and also can help lower total cholesterol in people on kidney dialysis. K3 and K4 still have much research pending. Those with Celiac disease not on a gluten free diet, chemotherapy, anticonvulsants or antibiotics may be at risk of vitamin K depletion, most likely due to the disruption in the bacteria of the gastrointestinal tract.

Good food sources of Vitamin K include dark leafy greens and to maximize absorption are best eaten with a source of fat (butter, olive oil, coconut oil, avocados). Olive oil actually is a source of vitamin K1 so it’s on double duty! Cheese, especially brie, egg yolks and fermented soy beans (natto) are also sources of Vitamin K.

Again, emphasize a diet with a full variety of  fresh wholesome foods, rather than supplementation. There are cases however where supplementation for the short term, and sometimes even the long term, is necessary for optimum health status. A naturopathic doctor has the training and resources to help you decide what is best for your individual requirements.

Dr. Laura M. Brown, ND

Source:

Gaby, A. (2011) Nutritional Medicine. Fritz Perlberg Publishing. Concord, NH.