Balancing Blood Sugar

1. Balancing Blood Sugar with Rachel Schaefer L.Ac, M.S

2. Objective: Maximize Balance . WHAT DOES NORMAL LOOK LIKE? Glucose from food is disposed via insulin in (primarily) muscle tissue and stored as glycogen. The other 10% will go to the liver and 5% will go to adipose tissue and other organs. Our muscles and liver use glycogen to protect in periods of starvation. If blood sugar drops low, the pancreas will produce glucagon. This hormone instructs the liver and muscle to convert the stored glycogen into glucose and return blood sugar to normal. Take home TIP: Use small portions of longer burning molecules (protein, raw fats) thru-out the day to avoid blood sugar drops and spikes. Exercise to build muscle to increase glycogen storage. Muscle cells are by far the most sensitive to insulin.

3. Normal Regulation

4. What happens in Dysregulation? • Once glycogen storage sites in the muscle and liver are filled, if glucose remains in the blood stream, it will be converted to and stored as fat— at the waist region, called centrifugal obesity. • Fat cells are inherently “insulin-resistant” whereas muscle cells are inherently insulin sensitive. • Insulin is an anabolic hormone, meaning it BUILDS, and alerts the body to store more fat. Excess insulin is also stored in the ovaries where it contributes to anovulation via the syndrome PCOS. Take home TIP: Increasing muscle mass will up-regulate responsiveness. Glycemically regulate diet to stimulate less insulin production and fat cell production

5. Early signs of Dysregulation -Yeast infections -Thirst and dry mouth -Excessive appetite, esp for sweets -Fatigue after meals -Hypoglycemic episodes: urgency for food and sweating palms, frustration when hungry -Excessive urination, especially at night -Frequent dental infections -Anovulation in female with centrifugal obesity -Aromatization (estrogen trending) in males -Fleeting anxiety, insomnia, depression. Often concomitant to bipolar and manic disorders -Blurry vision

6. HYPOGLYCEMIC ROLLERCOASTER

7. HYPOGLYCEMIA

8. Hypoglycemia is a form of glucose dysregulation • Excessive gluconeogenesis from the liver will tax beta cell insulin production from the pancreas. • Often accompanied by adrenal exhaustion. Cortisol is responsible for normalizing low sugars, so if IT is low, hypoglycemia will not be corrected.

9. Chicken or the Egg? Etiology of Type 2 Diabetes • How reliable are genetic markers for Diabetes and Glucose Dysregulation? Informative but not entirely predictive. • Obesity trumps • High lipids are correlated with insulin resistance. • Triglycerides are not the result of dietary fat intake. Fusion of carbohydrate consumption and existing body fat. High triglycerides=Predisposition to sugar imbalance. • All OBESE individuals are insulin-resistant, in that fat cells are inherently insulin resistant. • Take home TIP: Maintain or achieve normal BMI via diet and exercise

10. Uncontrolled Blood Sugar spikes • Hyperinsulinemia promotes inflammation, dementia, aging and infertility: • Insulin activates NF-kappa B transcription– source of inflammation. Inflammation is now thought to be at the etiology of nearly 90% of pathologies, from cancer, to arthritis, to heart disease. Insulin signaling may actually shorten lifespan • Insulin resistance increases production of testosterone in women—seen in PCOS and infertility • Metabolic syndrome contributes to dementia and cognitive impairment—associated with inflammation in the brain.

11. Nutritional Strategies • Eat Anti-inflammatory rather than Pro-inflammatory. But HOW? • Use Raw oils and avoid cooking with oils that become rancid—stick to Coconut and Ghee for high heat. • Use tumeric for its anti-inflammatory properties. • Use only organic forms of protein • Avoid excessive use of dairy product, esp non-organic. • Employ fish oils and prolyetic enzymes (i.e Wobenzyme between meals) • Support detoxification in the liver, kidney and skin. Start simply– lemon juice supports liver detox, unsweetened cranberry the kidney and gentle sweating thru the skin.

12. Good choices have GREAT outcomes

13. Unique Cause of Imbalance • Infection • Immune response triggers a stress reaction which raises blood sugar • Overeating • “Chinese Restaurant Effect”: even eating large amounts of glycemically stable foods require the body to spike higher than optimal insulin • Role of stress • Cortisol surging alters glucose control. Resultant “fight or flight” forces liver into gluconeogenesis-- even more sugar is produced for body to cope with! • One unique cause of stress: OVERTRAINING athletically. “Metabolic overtraining syndrome” is a literature documented condition leading to glycemic dysregulation and fatigue. The body chronically thinks it is being “chased by a tiger!” And the adrenal cortex hormones, like cortisol, become depleted. • Take Home TIP: Eat smaller meals more frequently and reduce stress

14. How to DE-Stress So if stress is a culprit in blood sugar instabililty, how to mitigate it? Intentional RELAXATION—meditation, yoga, guided visualization, walking following meals, technology breaks, assurance of proper sleep, pursuit of joy and sense of “safety” in relationship and environment. Lifestyle Practice: Elevated knees at 90 degrees for ½ hr between 2 and 6 pm Herbal medicines in the ADAPTAGEN class– Retrain the body to adapt to stress without cortisol surging (ie Rhodiola, Ashwangdha, American Ginseng, Astragalus)

15. What DIET is most effective? • No “ONE SIZE FITS ALL” • Individualized approach to achieving appropriate BMI. • High in phytonutrients and soluble fiber (beans). Low glycemic foods, healthy oils (raw oilve, cooking coconut), organic forms of protein, avoidance of allergic foods, reduction of carbs later in the day when they won’t be converted and used as energy. • Digestive function as modifier—what are YOU digesting? • Avoid undereating or eating in stressful conditions HOW to BALANCE: Start the day with protein based breakfast of high quality. Don’t exercise in the morning without some caloric imput to stabilize sugars. Follow exercise with fruit and protein to rebuild muscle. Create rituals around mealtimes.

16. Special Cases • Do NOT begin your day with COFEE or TEA without BF • Stimulates liver to produce sugars without caloric imput (Source of adrenal fatigue)– Can’t go without it? Test for and Treat Adrenal fatigue. • ALCOHOL • High in sugar, interferes with insulin response to food. Response becomes severe and overshoots. Reactive hypoglycemia common following a large meal where alcohol has been consumed. Avoid taking alcohol on an empty stomach where a large insulin surge will follow consumption but the actual food will not be there to cover (resulting in hypoglycemia) • Take home TIP: look for morning beverages with little or no caffeine and if consuming alcohol, have protein or fat in conjunction. Avoid excess.

17. Breaking Fast.. HOW To BALANCE: • “Break Fast”—numerous studies show that skipping this meal contributes to obesity and diabetes Type 2. Eating within an hour of rising contributes to weight control. • What’s for breakfast—Gluten free oatmeal with egg, Low glycemic smoothie with hemp protein powder. Lentils and brown rice with veggies. Greek yogurt with berries and walnuts. Egg based muffin with almond butter.

18. Simple Tips • CINNAMON on fruits will decrease sugar spikes. Cinnamon has an insulin-modulating affect. • Legumes for source of slow burning carbs and protein. • Where beans are substituted for faster-acting carbohydrates, postprandial blood sugars increased more slowly and peaks reduced. “Carb blocker” products usually contain legumes.

19. Traditional Chinese Medicine • Chinese Medicine Dietary theory To strengthen pancreas/spleen function, eat warm foods— pre-digested, such that the body does not have to effort. HOW to BALANCE: Root vegetables and Soups. Miso broth, Long cooked grains and grasses (millet, quinoa, wild rice). Fluids and Minerals– Seaweed. These strengthen the pancreas function and digestion. In heavy training periods, be sure to up protein intake and use “bone stocks” from organic meats to cook vegetables. Typical female should have a minimum of 60 gr protein daily. Athletes would need 20 more per hour of activity.

20. What is the ideal dietary support? • THE IDEAL FOOD FOR YOU is what you are capable of digesting! • Clinical investigation of your unique constitution • Digestive enzymes and probiotics may be useful to repairing the digestive tract should this be an issue. Blood sugar will spike in the intake of allergic foods (immune modulation effect) • Begin with a Food/Mood log to help your practitioner assess for digestive imbalance or food allergy. • Elimination/Provocation diets may be prescribed to vet potential irritants • Testing can be provided should the case merit deeper quantitative assessment

21. Day in the Life • Begin with a long burn breakfast • Prep protein and stabilizing snacks for the day • (Consider hard boiled eggs, jerky, bean dips, greek yogurt, almond butter and veggies, avocado and almond cheese) • Use support like Green Tea (TNF-alpha inhibitor, an anti-inflammatory action) only following a meal or chiro-d-inositol with higher carbohydrate meals to increase sensitivity. • Avoid undereating • Engage in exercise with an emphasis on muscle building and avoid overtraining or working “on empty” • Bring in a daily relaxation practice • Reduce carbohydrate intake as the day goes on • Assure an adequate night’s rest

22. Green Tea Works..

23. Constitutional Remedies • Chinese herbal medicine uses syndrome differentiation to assess imbalances particular to each patient. • Classical formulas are useful to pre-diabetic and diabetic conditions, a licensed herbalist modifies to an exact diagnostic picture. No two patients are alike. • Chinese herbalists are trained as “pharmacists” in the application and combination of over 300 single herbs. • Herbal formulas are typically given as teas, powders and pills.

24. Supplementation may be helpful • Vitamin D:Low levels contribute to metabolic syndrome. Deficiency linked to poor beta cell function and polycystic ovarian syndrome (PCOS). • EPA/DHA:Anti-inflammatory. Supports Regulatory T-cells. Healthy fat to ease sugar surges. • Pantothenic Acid (B5):helps produce energy from glucose and modulate lipid metabolism. Lowers LDL cholesterol, triglycerides and raises HDL. • Chromium:Essential mineral, also known as “Glucose Tolerance Factor”—positive effect on insulin sensitivity, lower cholesterol and triglycerides, raising HDL and improves body composition. • Alpha Lipoic Acid:Works on liver detoxification, lowers serum glucose, treats peripheral neuropathy.

25. Exercise for optimal blood sugars • Exercise every day or every other. 72 hour window for cumulative effect. 25 minutes is sufficient. • Aerobic exercise lowers blood sugar. • Criteria: something that doesn’t bore you, something that doesn’t cause problems for your body. Pool exercise is often useful to those with joint discomfort. • Strenous exercise will raise HDL and lower triglycerides. • Anaerobic exercise (body building or strength generating yoga) lowers serum LDL. • Muscle reduces insulin resistance. Muscle stores glycogen efficiently.

26. Take a walk 30 minutes after a meal

27. Post-Exercise Nutrition • THE CAVEAT • To normalize sugar levels, ingest higher glycemic food, like watermelon or other fruit, immediately following exercise. • Restores glycogen in muscle tissue for the next workout. • Protein intake within an hour for muscle repair and growth. Also prevents sugar spiking from the high glycemic snack.

28. Multiple Factors • “What if STRESS or sluggish digestion are causing my blood sugar imbalances?” The typical patient: 40 yr old female, overworked, fatigued with sugar cravings and excessive urination. Tends to gas and bloating with meals. Anovulatory cycles and infertility HOW to BALANCE: Acupuncture treatment to retrain nervous system, strengthen digestion and endocrine signaling. Dietary intervention to make empowered choices for energy production and glycemic support.

29. Acupuncture • Acupuncture enjoys many centuries of clinical trial • Meridian systems affect physiological changes • As thin as a strand of hair, acupuncture needles are sterile and disposable • Research shows that acupuncture decreases cortisol production. This lowers sugar production by the liver.

30. Integrative Medicine What’s available to you? -Herbal formula written constitutionally -Acupuncture to modify stress response and treat imbalance -Holistic lab assessment: assessing physiological FUNCTION—thyroid, adrenal fatigue. -Digestive assessment: what do you assimilate, what to avoid, how to maximize absorption. Blood typing. -Detoxification program development -Wellness coaching: Step by step modifications as you go

31. Resources Books to get you started: The Practical Paleo Cookbook Ultrametabolism Cookbook The Paleo Diet for Athletes Elana’s Pantry (blog) Food prep and delivery: Three Stone Hearth (Based in berkeley) Good Eggs Square Meals

32. Monitoring Begin with a three day Food/Mood Log *This includes what you’ve eaten and how you “felt” with intake (digestion, energy, mood) *Note other things that alter your blood sugar, like exercise, stress, lack of sleep, changes in menses, colds etc. Note pitfalls/challenges in meeting your objective. *Use a glucometer if you’d find it useful to test different meals or conditions against one another Take home TIP: accounting makes assessment easy!