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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.
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Lahnor Powell, ND, MPHMedical Education Specialist - Atlanta
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Melanie Dorion, AGNP
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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.
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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
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• Contributing factors to nutrient imbalances in obesity– Medications
– Toxins
– Gut dysbiosis and NAFLD
• Oxidative stress– Phase II detox
– Methylation
• Testing
• Management
• Cases
Outline
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Contributing Factors to Nutrient Imbalances in Obesity
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Nutrient Prevalence
Vitamin C 35-45%
Vitamin D 80-90%
B12 9-10%
Folate 25%
Iron 13-19%
Obesity
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Medications
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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
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PPIs
www.mytavin.com
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• 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.
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• 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.
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Endocrine Disrupting Chemicals (EDCs)
EDCs
DDT
PCBs, PBBs, PBDEs
BPA
Phthalates
TBT
Synthetic Hormones
Mycotoxins
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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
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Non Alcoholic Fatty Liver Disease (NAFLD)and the microbiome
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• 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.
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• 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.
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“[…] 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.
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Oxidative Stress and Obesity
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• 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.
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Nrf2 ActivationARE
Nutrients
Toxins
Phase I
Phase II
Phase III
Keap1
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• 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
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MTHFR
– B12
– FAD (B2)
– NADP (B3)
– folic acid reduces the activity of the folate pathway
Methylation
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• Tripeptide: glutamate, cysteine and glycine
• Magnesium
• Selenium
• Glycine
• B6
Glutathione
Image from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704241/pdf/nihms119862.pdf
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Testing
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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
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• 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
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Functional Testing
Bralley, J. A., & Lord, R. S. (2012). Laboratory evaluations for integrative and functional medicine. Duluth, Ga: Metametrix Institute.
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Nutrition
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Nutrition
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Nutrition
• Lipid peroxides: cell membrane damage
• 8-OHdG: DNA damage
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Methylation
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Methylation
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• 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
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• 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
2
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• 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
3
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Management
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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
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Food First
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Nrf2 ActivationARE
Support Phase II
Nutrients
Toxins
Phase I
Phase II
Phase III
Keap1
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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.
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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
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• 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.
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Clinical Case 1Mold illness, MCAS, and SIBO
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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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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.
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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.