functional nutrition testing in obesity - gdx

Functional Nutrition Testing in ObesityMelanie Dorion, AGNP

The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.

Lahnor Powell, ND, MPHMedical Education Specialist - Atlanta

Melanie Dorion, AGNP

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• Review factors that lead to nutrient imbalances in the obese patients

• Review the impact of oxidative stress on the obese patient

• Apply diagnostic testing to evaluate areas that may play a causative role in the etiology of obesity

• Develop a comprehensive nutritional strategy for successful weight loss and weight loss maintenance

Objectives for This Presentation

• Contributing factors to nutrient imbalances in obesity– Medications

– Toxins

– Gut dysbiosis and NAFLD

• Oxidative stress– Phase II detox

– Methylation

• Testing

• Management

• Cases

Outline

Contributing Factors to Nutrient Imbalances in Obesity

Nutrient Prevalence

Vitamin C 35-45%

Vitamin D 80-90%

B12 9-10%

Folate 25%

Iron 13-19%

Obesity

Medications

Medications in Obesity

www.mytavin.com

LaValle JB: Consequences of Cardiovascular Drug-Induced Nutrient Depletion. Pp.369-404.

Medication Nutrient at Risk

Beta Blockers CoQ10, melatonin

Loop Diuretics Ca, Mg, K, Zn, B1, B6, vit C

ACE Inhibitors Zn, Na

Metformin B12, folate, CoQ10

PPIs B12, Ca, Mg, Zn, Folate, Fe

Statins Zn, Se, CoQ10, EFA

Wellbutrin (Contrave) Tyrosine, Na

Topiramate (Qsymia) GSH, folate

PPIs

www.mytavin.com

• The US permits more than 84,000 chemicals to be used in household products, cosmetics, food, and food packaging – Most of these have never been tested for safety

• Personal care products are manufactured with over 10,000 chemical ingredients– Some are known or suspected carcinogens, toxic to the

reproductive system or known to disrupt the endocrine system

Toxins

https://environmentamerica.org/news/ame/206-million-pounds-toxic-chemicals-dumped-america%E2%80%99s-waterways.

https://articles.mercola.com/sites/articles/archive/2015/12/08/toxic-chemical-health-risks.aspx.

https://www.ewg.org/skindeep/2011/04/12/why-this-matters/#.WxH-eEgvxPY.

• The rise in obesity and multiple chronic diseases parallels the rise in chemicals in our environment

Linking Chemicals to Disease

http://www.diabetesandenvironment.org/home/incidence.

Endocrine Disrupting Chemicals (EDCs)

EDCs

DDT

PCBs, PBBs, PBDEs

BPA

Phthalates

TBT

Synthetic Hormones

Mycotoxins

Endocrine Disrupting Chemicals (EDCs)

EDCs• Pesticides and Fungicides

– DDT– Vinclozolin

• Industrial Chemicals– PCBs– PBBs & PBDEs– DDT

• Plastics and Plasticizers– BPA– Phthalates

• Organotins/TBT• Synthetic Hormones

– DES

• Natural EDCS– Phytoestrogens

• Mycotoxins

Obesogens

PCBs, PBBs, PBDEs

BPA and Phthalates

• From plastics

• Environmental estrogen

Mycotoxins

• Secreted by mold to protect their “territory”

• Toxic to humans

TBT

• In paint to prevent fouling on boats & disinfectants

Non Alcoholic Fatty Liver Disease (NAFLD)and the microbiome

• The prevalence of NAFLD is 15-30% of the general population and 50-90% in obesity

• Choline

– Choline is an essential nutrient obtained through diet and endogenous synthesis • Methylation!

– Reduction of choline metabolism which reduces efflux of VLDL from hepatocytes = inflammation

– Degradation of choline by the microbiome mimics a choline-deficient diet = can induce NAFLD

Gut Dysbiosis and NAFLD

Divella R, et al. Int J Biol Sci. 2019;15(3):610-616.

Aragones G, et al. Biomed Res Int. 2019;8507583.

• Alteration of gut microbiota promotes the

development of NAFLD by mediating/affecting

• Processes of inflammation

• Insulin resistance

• Bile acids and choline metabolism

• NASH patients often have SIBO

• May impair the intestinal tight junction and

subsequently increase intestinal permeability

• Also induces hepatic expression of TLR4 and release

of IL-8 that stimulates inflammatory reaction

• LPS forms binding complexes that trigger

inflammation and insulin resistance

Microbiome and NAFLD

Ma Junli, et al. Nutrients. 2017;9(10):1124.

“[…] gut dysbiosis is causative for enhanced secretion of LPS and its mediated inflammation in NAFLD development.”

Ma Junli, et al. Nutrients. 2017;9(10):1124.

Oxidative Stress and Obesity

• RDA most likely not sufficient to prevent subtle metabolic damage and oxidative stress

• DNA damage and oxidative lesions– Inadequate intake of B12, folate, B6, C, E, and Fe

– About half the population may be deficient in one of these

• Mitochondrial damage– Iron and biotin (B7) deficiency

– ¼ of U.S. menstruating women ingest <50% of the RDA

DNA and Mitochondrial Damage

Jones, D. S. (2010). Textbook of functional medicine. Gig Harbor, WA.: Institute for Functional Medicine.

Nrf2 ActivationARE

Nutrients

Toxins

Phase I

Phase II

Phase III

Keap1

• Proteins– Glycine, glutamate, methionine, serine, cysteine, and acetylcysteine

• Vitamins – B2, B3, B6, B9/folate, and B12

• Minerals– Magnesium, selenium, and zinc

Phase II is Heavily Nutrient Dependent

MTHFR

– B12

– FAD (B2)

– NADP (B3)

– folic acid reduces the activity of the folate pathway

Methylation

• Tripeptide: glutamate, cysteine and glycine

• Magnesium

• Selenium

• Glycine

• B6

Glutathione

Image from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704241/pdf/nihms119862.pdf

Testing

Standard Lab Testing

• CBC– MCV

• Ferritin

• B2– Whole blood

– G6PD deficiency can mask B2 deficiency

– Hypothyroid and adrenal dysfunction decreases activation of B2 → FAD

• B6– Plasma

• B9– Do both Serum and RBC

• red blood cells reflects total folate status, while folate in plasma or

• serum reflects almost exclusively methylfolate

• B12– Serum and methylmalonic (MMA)

– biotin deficiency could blunt the production of MMA

• Homocysteine (hcy) (optimal 5-8)– > indicates B6, B9 or B12 deficiency

• Magnesium– Serum and RBC

– 24-H urine: high in urinary loss

• Selenium– Plasma (vs serum or whole blood)

• Zinc– Plasma (vs serum or whole blood)

– Ideal range 70-120mcg/L

Standard Lab Testing

Functional Testing

Bralley, J. A., & Lord, R. S. (2012). Laboratory evaluations for integrative and functional medicine. Duluth, Ga: Metametrix Institute.

Nutrition

Nutrition

• Lipid peroxides: cell membrane damage

• 8-OHdG: DNA damage

Methylation

• Homocysteine (hcy) (optimal 5-7)– Elevated: may indicate B6, B9, B12 deficiency

or need for methyl donors

• Methionine1. High with low HCY = not converting

methionine to SAMe

2. Normal with high HCY = B6 def

3. Low with high HCY = deficiency in methyl donors

Methylation

1


methionine to SAMe



Methylation

2


methionine to SAMe



Methylation

3

Management

Test and don’t guess!

Root cause

• Deficiencies due to– Inadequate intake

– Increased need

– Decreased absorption

• Food first

• “Open” the pathway

• Medical food/meal replacements

Correcting Imbalances

Food First

Nrf2 ActivationARE

Support Phase II

Nutrients

Toxins

Phase I

Phase II

Phase III

Keap1

KEAP1

• Zinc

• Selenium

• sulforaphane

Nrf2

• Low doses

• Isoflavones

• EPA/DHA

• Turmeric

• Sulforaphane

• Tocopherol

Nutrients for Oxidative Stress KEAP1 and Nrf2 Support

Miller, Bob. Unraveling Complex Chronic Illness. Forum for Integrative Medicine. (2018).

© NutriGenetic Research Institute 2018.

Supplements

Glucose Support

• MetaglycemX, Metagenics

• Metabolic Synergy, Designs for Health

Detox Support (Prep The Gut!!)

• PermaClear, Thorne

• Lipotropic Complex, Integrative Therapeutics

• GI Detox, Bio-Botanical

• Liver-GI Detox, Pure Encapsulations

• BrocElite, Epiceutical Labs

B Vitamins

• Stress B, Thorne

• B Minus, Seeking Health

• B lozenges– Non methylated: Biotics B12-2000

• IM – B12

– B complex – add 0.5-1cc of lidocaine

– Lipotropic solution

• IVs– Saline with magnesium

– Myers’ cocktail – safety and efficacy

– High dose vit C with Myers’

– ALA – start low and go slow

– Phosphatidylcholine

• Patients may feel exhausted at first

IM and IV

Gaby, AR. Altern Med Rev. 2002;7(5):389-403.

Clinical Case 1Mold illness, MCAS, and SIBO

Clinical Case 2Lyme and Bart

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Lahnor Powell, ND, MPHModerator

Melanie Dorion, AGNPPresenter

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March 25, 2020

The New GI Effects Report: Advancing GI Testing Through Microbiome AnalysisMichael Chapman, ND

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functional nutrition testing in obesity - gdx

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