February 28, 2019 at 3:10 pm #861Lucille BleekersParticipant
this lady has come to me as she has been trying to fall pregnant for 12 years. She has tried IVF twice (this has been back home in Oman and the last attempt was in 2013) and wants to try again but needs to get her BMI down so her main focus now is to lose weight. Her current BMI is 42.6. She has quite a complex history in that she has been asthmatic since she was 3 years old and I think she really suffered quite badly with it until it was finally stabilised. She feels this is when her weight first started being an issue (so around the age of 8 years old).
In 2005 she was given the diagnosis of PCOS but can’t really give me any more information here, other than to say that she was able to release eggs with assistance.
In 2014 she was given the diagnosis of Type 2 Diabetes and put on metformin. There is also a family history of Diabetes.
She has tried a variety of diets and attended weight loss centres however without much success. I believe one was quite restricted and she was found to have B12 Anaemia and for a while received B12 injections. She has had thyroid testing which came back normal but no recent tests. She has had some hormone testing, also in the past so could not provide me with anything.
The client feels very stressed and anxious at the moment as her father has recently been diagnosed with rectal cancer and she is in the last stretch of her PhD here in the UK. She has no real support structure here as all her family and her husband are all back in Oman.
Further health issue – the client has allergies to shellfish, kiwi’s and animal hair – she takes a daily antihistamine due to itchy skin, particularly her hands – she explained that she does not come out in a rash, it sounds more like wheels (reddish raised lines that appear on the skin when scratched, they do not swell up). She also did a York Test in 2017 and was found to have a yeast sensitivity.
We discussed finding a form of yoga which would have the added benefit of helping with relaxation. The client’s mood can also fluctuate and she does have periods of low mood.
As I said above my initial thinking is to work on the gut and help her to balance her blood sugar levels, however, as there are a few things going on for this lady I do wonder what testing would give the most useful information at this stage. I have already suggested as a first port of call that she ask her GP for up to date bloods on the most obvious ones such as iron, Vit D, B12, Thyroid.
Any guidance would be greatly appreciated.
Posted by Lucille Bleekers 28.02.19
March 5, 2019 at 3:12 pm #862Christine BaileyModerator
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
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