Welcome! › Forums › 38 yo F overweight, fertility issues, type 2 Diabetes › Reply To: 38 yo F overweight, fertility issues, type 2 Diabetes
Many thanks for your question about your client who is obese, struggling with fertility and has been previously diagnosed with a number of allergies and PCOS.
As you mentioned, she has type 2 diabetes I would support your suggestion of looking at how well she is managing her blood sugar. Check her HBA1C, C Reactive protein (CRP) and fasting glucose levels. I believe that weight loss really is the key area to focus on here. As she starts to lose weight I do believe that many of the other symptoms will improve.
Yes, it may be useful to recheck the thyroid function but the key here is blood sugar control and weight loss.
There could be a number of approaches to try such as fasting mimicking diet, intermittent fasting, low carbohydrate etc, but it is likely she will need a very structured programme and meal plan to keep her focused. As she has little support in the UK you may need to offer regular follow up consultations including teleconsults or skype consults to keep her focused as she has tried many previous diets in the past without real success.
Her allergies and asthma suggest imbalances in immune response so you may wish to look at probiotic support to modulate immune response. It is important to remove the known triggers 100%. You mention she has a yeast sensitivity (IgG) do you suspect any gut infections at all? Enteric bacteria modulate intestinal morphology; they also produce short chain fatty acids, vitamins, ferment dietary fibre, and shape mucosal immunity. Animal models have shown that enhancing or restoring intestinal commensal bacteria through supplementation (i.e. supplemental probiotics) can induce tolerance and prevent sensitivity & allergy. Evidence also suggests that a healthy population of intestinal bacteria can help reduce intestinal permeability.
Sudo N, Yu XN, Aiba Y, et al. An oral introduction of intestinal bacteria prevents the development of a long-term Th2-skewed immunological memory induced by neonatal antibiotic treatment in mice. Clinical and Experimental Allergy. 2002;32(7):1112–1116 https://tinyurl.com/y9yawd8e
Gun F, Salman T, et al. Effect of probiotic supplementation on bacterial transaction in thermal injury. Surg Today . 2005;35(9):760–4. https://tinyurl.com/yc22qod8
In view of where her family come from, which is known for its air pollution, do you suspect any toxic load? In which case a detox programme first may be helpful.
In terms of support for blood sugar you may wish to look at supplements to improve insulin sensitivity and blood sugar handling.
Regular exercise improves blood glucose control, lowers risk of cardiovascular disease, aids in weight loss, and improves overall health. While she may not be able to engage in vigorous exercise initially I would encourage her to start a programme with personal trainer or similar
Moderate exercise, such as rapid walking for 30 minutes per day, five days per week, has been shown to substantially lower the risk of type 2 diabetes
Colberg SR et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care. Dec 2010;33(12):e147-167. https://tinyurl.com/jml3rp6
Metformin does interfere with absorption of vitamin B12, increasing the risk of vitamin B12 deficiency. Low B12 levels, in turn, may contribute to elevated concentrations of homocysteine – an independent risk factor for cardiovascular disease.
Niafar M, Hai F, Porhomayon J, et al. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med. 2015;10(1):93-102. https://tinyurl.com/yb7mwy68
Blood sugar imbalances can also promote inflammation so including plenty of anti-inflammatory nutrients and foods in her diet would be appropriate. CoQ10, turmeric, green tea extract, Resveratrol, lipoic acid, vitamin E, Grape polyphenols are some examples.
Various nutrients can improve insulin sensitization. These include chromium, cinnamon, omega 3 fats, magnesium.
Hoffman NJ, Penque BA, Habegger KM, Sealls W, Tackett L, Elmendorf JS. Chromium enhances insulin responsiveness via AMPK. J Nutr Biochem. 2014 May;25(5):565-72. doi: 10.1016/j.jnutbio.2014.01.007. Epub 2014 Feb 20. View Full Paper
Medagama AB. The glycaemic outcomes of Cinnamon, a review of the experimental evidence and clinical trials. Nutr J. 2015 Oct 16;14:108. doi: 10.1186/s12937-015-0098-9. View Full Paper
Chutia H, Lynrah KG. Association of Serum Magnesium Deficiency with Insulin Resistance in Type 2 Diabetes Mellitus. J Lab Physicians. 2015 Jul-Dec;7(2):75-8. doi: 10.4103/0974-2727.163131. View Full Paper
(It should be noted that serum magnesium is not nearly as accurate a marker for magnesium status compared to intra-cellular magnesium for which a RBC magnesium test is required.)
Vitamin D deficiency has been associated with both diabetes and obesity, and evidence suggests vitamin D status is closely related to glucose metabolism. People with low vitamin D were more likely to have diabetes, independent of their body weight.
Clemente-Postigo M, Munoz-Garach A, Serrano M, et al. Serum 25-hydroxyvitamin D and adipose tissue vitamin D receptor gene expression: relationship with obesity and type 2 diabetes. J Clin Endocrinol Metab. 2015;100:E591-E595. https://tinyurl.com/jzptren
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Blood sugar support
GlucoBalance (BRC) – take 2 with each meal – https://tinyurl.com/jfhvyum
Glucofit (ARG) – take 1 30 minutes before lunch and dinner – https://tinyurl.com/gwwkcnk
ALA Release (sustained release lipoic acid with biotin) (ARG) – take 1 with each meal – https://tinyurl.com/hp72kvl
Hepatic Biotransformation (Detox) Support
Nutri Clear (BRC) – take 1 serving daily – https://tinyurl.com/z7k2x57
Gut and immune Support
Lactobacillus Culturelle GG (ARG) – take 1 twice daily – https://tinyurl.com/zonwo4a
I hope this helps with this client
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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