2023 REVIEW: WHAT WE NOW KNOW ABOUT TYPE 2 DIABETES IN AMERICA (Part 1)

DIABETIC NEUROPATHY AND THE GLOBAL PANDEMIC

6/23/2023 - Dr. Paul Dreschnack, 4-time Nobel Peace Prize nominee for clinical studies on cell regenerative therapeutics announced an upcoming exploratory research on what may just be the most groundbreaking treatment strategy for Type-2 Diabetes.  From a recent interview, IPHA NEWS editors  contacted Dr. Dreschnack to introduce his latest project (release), starting with some astounding statistics about our current global data.  "You can read the latest stats from The International Diabetes Federation... where an estimated 425 million people worldwide have diabetes, making it the largest global epidemic of the 21st century. 115 million people in China, 73 million in India and 30 million in the United States have diabetes3. Other estimates include 388M from China, 133M in India and 85M in the United States."  He also expounded on the global health expenditure at $727 billion with no slow-down in sight.(1)  All this data calls for an action plan that Dr. Dreschnack is excited to spearhead with his 2023 Extracellular Vesicles research program.

DIABETIC NEUROPATHY
Diabetic neuropathy is comprised of various types of nerve damage associated with diabetes mellitus. Symptoms can include weakness, sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. [2]  The different types of diabetic neuropathy include Peripheral neuropathy --nerve damage that typically affects the extremities-feet, legs or hands). Another type is Autonomic neuropathy which is comprised of damage to nerves that control your internal organs. Focal (damage to single nerves) and Proximal neuropathy- a rare and disabling type of nerve damage in your hip, buttock, or thigh. [3]

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096070/

2) https://en.wikipedia.org/wiki/Diabetic_neuropathy

3) https://en.wikipedia.org/wiki/Diabetic_neuropathy

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Meet our newest Functional and Holistic Health Expert- Dr. Robert Kornfeld.  In this issue, IPHA NEWS features Dr. Kornfeld's advanced knowledge in the topic of Type-2 diabetes. He is a seasoned researcher and therapist in functional medicine and is well-published and broadcast for his expanded insight on chronic disorders.  Originally promoted as a certified Podiatrist, he employs this specialized study to add to his diagnostic insight to support the management of chronic disorders while building prevention and wellness care for his many patients. 

BATTLING DIABETES WITH FUNCTIONAL MEDICINE 
From an interview with Dr. Robert Kornfeld

A diabetic patient may walk into my office with painful neuropathy or pain caused by vascular disease from the microangiopathy (microscopic blood vessel disease). What I discover in almost 50 to 60% of these patients is that their hemoglobin A1C is normal and their endocrinologist or internist tells them everything's great. You’re well controlled. And they'll share that with me when they walk in. So my question to them at that point is “Then what are you doing here? If everything's fine, why are you 

here”? 

We must take a bird's eye view of the entire condition because there's a lot of different aspects to diabetes. TYPE-2 is an epidemic in this country and we need to start addressing all the possible downstream drama. 

STRATEGIC INTERVENTION OF THE DIABETIC PATIENT
Too many walk into doctor's offices in this day and age with open wounds that don't heal. And now, we have a whole new subspecialty in podiatry called wound care and it exists because it's really necessary.  How many antibiotics can you give them before it starts to wreak havoc on their kidneys, on their microbiome and essentially, on their immune system? In addition, there are larger problems with bone infection and eventual amputation.  We have a fine line that we must walk with these patients because unfortunately diabetes also damages kidneys, it can damage the retinas. There is a lot of secondary pathology that we can avoid with proper understanding of what's going on in this patient’s epigenetics.  I’ll also look into possible DNA mutations that interfere with normal healthy immune function and if we find them, we can intervene on behalf of those mutations and change the dynamics of that patient's physiology.

The very first thing I do as a functional medicine specialist is to have the patient JOURNAL their diet. Even though they're supposedly well controlled (medically), I get back diet journals that are 60, 70, sometimes 80% carbohydrate. Now we know why the patient is a diabetic. So I explain to them your A1C reading is an average. If you spike up and then fall below and spike up and fall below, it may come out a decent average over time, but every time your blood sugar spikes, there are certain things that happen. 

(To be continued)

ESSENTIALS OF GENOMIC TESTING   By: Dr. Roberta Kline DNA (deoxyribonucleic acid) makes up the genes that contain the blueprint for how our bodies operate ‐ from energy production in mitochondria to walking and breathing, from cellular health to digesting food, from thinking and running to protection from viruses, how we age and more. While humans are 99.9% alike in our DNA, it's the difference in that 0.1% that makes us each unique. Much of that difference comes from millions of small changes in our DNA. Genomic testing focuses on these small changes in DNA called single nucleotide polymorphisms (SNPs) that potentially predispose to disease or problems with medications by altering the body's biochemistry. But knowing about these potential areas of weakness is just the first step. The powerful part is that we know how to modulate their impact, thus potentially changing the outcome by reversing course, delaying onset or even preventing a disease process altogether. By decoding the instructions contained in DNA, each person becomes empowered with their own operating manual as to what they need for health. They can let go of the struggle as their blueprint guides them to the diet, lifestyle, exercise, supplements and medications that are best suited to their genes. And because we are only human, when life throws a curveball, having this personalized roadmap helps to get back on track much faster and with more precision. ▪NUTRIGENOMICS evaluates DNA to provide personalized diet, lifestyle, supplement and exercise recommendations for prevention and disease management strategies. ▪ONCOGENOMICS is a sub-field of genomics that characterizes cancer-associated genes. It focuses on genomic, epigenomic and transcript alterations in cancer. ▪PHARMACOGENOMICS evaluates DNA to provide personalized medication guidance for current and/or future medications. Extra: "THE FUTURE IN PERSONALIZED MEDICINE" (3/3/2022)

IMPACT OF DIABETES ON THE BRAIN
By Marilyn Abrahamson, MA,CCC-SLP - CBHC

Diabetes is a chronic condition that causes high levels of sugar in the blood (glucose) and wide glucose excursions (where glucose levels are uncontrolled, fluctuating from high to low and back again). These can have negative effects on the body, including the brain. Recent scientific research has determined that diabetes can harm cognitive function and the structure of the brain. Acknowledging and understanding the effects that diabetes has on the body and brain is important so we can intervene early and effectively to manage the disease.

HOW DIABETES AFFECTS COGNITIVE FUNCTION
Research has shown that people with diabetes are more likely to experience cognitive decline with an increased risk for Alzheimer's disease and other types of dementia. Diabetes mainly affects four cognitive domains; attention, processing speed, executive function, and memory. Both type 1 and type 2 diabetes can cause these cognitive problems, which suggests that high blood sugar, wide glucose excursions, and insulin resistance all play important roles.

HOW DIABETES AFFECTS THE BRAIN
There are several ways in which diabetes can harm the brain. High blood glucose, or wide glucose excursions cause:

    ● Oxidative stress: causing certain types of toxins called free radicals to build up in the blood. 

    ● Inflammation: can damage blood vessels, and impair brain function. 

    ● Insulin resistance:  a common feature of type 2 diabetes, which can disrupt and damage important neural pathways in the brain needed to function normally.

BRAIN IMAGING RESEARCH has shown that diabetes can also cause changes in the brain’s structure. Certain areas, like the hippocampus, frontal lobes, and basal ganglia, are particularly vulnerable to damage, which can result in reduced brain volume (size) as a result of the reduction of gray matter. These changes may also explain why people with diabetes often experience cognitive problems and have a higher risk of developing Alzheimer’s disease and other types of dementia.

PROTECTING THE BRAIN & MANAGING DIABETES
Detecting and managing diabetes early is crucial for minimizing its impact on the brain and how it functions. Lifestyle choices that support and healthy body and brain, such as regular exercise, a healthy diet, and maintaining a healthy weight, are important for controlling glucose and for managing diabetes. Medications, like insulin and other drugs, can also help regulate glucose levels. Taking care of cardiovascular health by controlling blood pressure and cholesterol is essential because these factors contribute to both diabetes and cognitive decline.

*See other BRAIN HEALTH ARTICLES by Marilyn Abrahamson
● What is Brain Training? [article & video]
● The Doorway Effect – Why We Forget Why We’ve Walked Into a Room [article & video]
● Post-Covid Brain Fog vs. Work Performance

MARILYN ABRAHAMSON, MA, CCC-SLP : As a Brain Health Education Specialist at Ceresti Health, Marilyn offers initiatives that supports education and empowerment of family caregivers and she is part of the editorial team at the Ceresti monthly newsletter- producing all brain health education &  coaching programs for caregivers.  Marilyn's prior work is as a NJ Licensed Speech-Language Pathologist since 1987 and is an Amen Clinics Certified Brain Health Coach.

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(Continued- "Battling Diabetes with Functional Medicine- with Dr. Robert Kornfeld")

BIOCHEMICAL EFFECTS OF SUGAR BUILD-UP

The buildup of sugar in the bloodstream causes damage to the inside lining of microscopic blood vessels. So these patients wind up with microscopic vascular disease, we call it microangiopathy. The nerve cells of the foot receive all their nutrition from microscopic blood vessels. The skin receives nutrition from microscopic blood vessels. Over time, if the patient starts failing in the microscopic blood vessel realm, they will develop painful neuropathy, painful vascular disease, wounds that won't heal, infections that are difficult to manage because the body cannot deliver immune cells to attack whatever bacteria is colonizing in the area and in the worst case scenario, bone infection and gangrene.

Although they probably did take a class on diabetic diets, most don't follow them. Part of my job as a doctor is to educate them, not just to say here's a good way to eat, but if you continue to eat this way, this is what happens. However, if you eat this new way, we can prevent and in many cases reverse a lot of the damage. So we key in to keeping the blood vessels healthy, making sure they're properly hydrated, making sure there's zero refined sugars in their diet, making sure they're eating their carbs at the right time of day. And that's kind of a patient specific issue. 

One of the big issues we come across with diabetics is many of them have anxiety and depression. As soon as sugar builds up in the bloodstream, the brain thinks you're in danger. The brain thinks you're having a survival challenge because when a predator wants to consume you, we have a hormone that's released from the adrenals called cortisol.  Its job is to signal the cells to dump sugar into the bloodstream.  Sugar builds up in the bloodstream and the brain reacts as if there is a survival challenge. One of the problems is as time goes on, we start to see an excitatory neurotransmitter dominance. Those are the neurotransmitters that wake us up in the morning, help us to think, help us to understand and reason they give us our stimulus to problem solve. But one of the excitatory neurotransmitters is called epinephrine and it is a very, very powerful and potent peripheral vasoconstrictor. So every diabetic has to have an adrenal neurotransmitter assessment to see if we're dealing with an excitatory dominance. Otherwise, the eventual loss of circulation due to clogging and spasming of the microscopic circulation will surely lead to amputation.

Insulin-Dependent & Non Insulin-Dependent Diabetes Mellitus.

Even when we control the diet, we can still wind up with persistent problems in the adrenal neurotransmitter- HPA axis. This is often addressed through dietary changes and through amino acid therapy, certain herbs and nutrients, adequate hydration and exercise (so many of them are classic couch potatoes).

Included in the many health areas to consider with diabetes, there's also an issue with immune function. We find with many diabetics, a problem in the ratio of copper and zinc. In the standard American diet, copper levels go way up and zinc levels begin to drop and the immune system goes to sleep.  To reawaken it, we need to find out what's going on in that ratio- and in many cases, we can (carefully) supplement with an appropriate level of zinc.   On the other hand, when you give a patient too much zinc, this can elevate some of the B vitamins to the point where they can cause neuropathy. So everything has to be managed. 

There's important lab testing involved when coming up with the right therapeutic plan.  There are metabolic antioxidants that protect nerve cells from damage. One of them is called alpha lipoic acid. And it's an important adjunct to what we do with diabetics because it is neuroprotective. Just as important is it is also neuro-regenerative. Same thing with blood vessels. We want to keep them patent and open and delivering blood. So managing the elevation in excitatory neurotransmitters and making sure they have enough magnesium (which is one of the most important nutrients to keep blood vessels supple and able to pump blood) is essential.

Magnesium is one of the most common nutrient deficiencies in America. Sometimes we have to augment the nitric oxide pathway with things like l-arginine or some of the other nutrients that help to create a more flexible and responsive arterial tree.  

Diabetics also have a very difficult time neutralizing and eliminating free radicals, which are the positively charged ions that damage our cells. We do an oxidative stress blood test to look at breakdown products of cell membranes so we know what level of oxidative stress they're dealing with. All of these can be quantified by lab work, but it's different lab work than just looking at an A1C or a fasting blood sugar and telling the patient, well everything seems fine right now. It's such a small part of what we have to do to keep these diabetic patients healthy. And to be honest, so many of them can get off or decrease their medication if they actually were taught exactly what they needed to do because they do all know that this could lead to disability and amputation. And it's not a pretty sight at all. 

These are generalities because so much of what we do in functional medicine is patient specific. Most importantly, we need to educate our patients and support them toward a different and more health-promoting lifestyle.  Right now, approximately 40 million Americans have been diagnosed with Type-2 Diabetes. We are seeing increases of about 1,000,000 new diagnoses each year. We need to work much faster on controlling underlying mechanisms of pathology lest this problem will totally break the “medical bank”.

In closing, I will say that the approach to preventing diabetic disasters must be built from the ground up!

DR. ROBERT KORNFELD is a Podiatric Specialist with an expanded background in Functional Medicine. His intensive focus on treating chronic foot/ankle pain through a functional medicine model enables him to  train podiatrists in the paradigm of integrative/functional medicine for foot and ankle pathology.  He founded a course called FAST TRACK TO A FUNCTIONAL MEDICINE DIRECT-PAY PRACTICE FOR PODIATRISTS that is available through an online educational platform.