A recent patient was concerned that despite watching her diet and taking her diabetes medication her hemoglobin A1C (HbA1c) keeps going up.
Remember, HbA1c is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabetes. 
An elevated HbA1c greater than 5.7% indicates that the diabetes is not well regulated and is in fact accelerating aging, increasing your chances of getting painful neuropathies, kidney failure needing dialysis, cataracts, amputations, and retinopathy blindness.
What could possibly be missed by her primary doctor?
One major cause of the unregulated glycosylated hemoglobin is an unrecognized B6 deficiency.

An excellent “functional” test to check for a pyridoxine (B-6) deficiency is the xanthurenate organic acid test. An elevated xanthurenate test is a sensitive marker for a B-6 deficiency.
 
But wait.. there is more to the story.
You can take B-6 and it may not work.
Why?
Because of a zinc deficiency.
When hidden zinc deficiency is present, the body cannot convert B6 to its active form, pyridoxal-5-phosphate or P5P. P5P, essential in normalizing the glycosylated hemoglobin and its deficiency, is an indicator that improperly metabolized sugars are accelerating aging, cataracts, kidney failure, heart disease, nerve damage and more.

But there is more to the story.
Elevated stored phthalates (plastics) in the body interfere with zinc metabolism.

This is the power of functional medicine. Seeking to find the cause of the cause of the cause.
HbA1c ---> B-6 deficiency ---> Zinc deficiency ---> Stored Phthalates
I have never yet met a diabetologist who even orders the above much less knows how to interpret it.
To ignore fixing the chemistry in an overtly metabolic disease is outright wrong.
Unfortunately, what I have seen from reading thousands of medical records is the fact that most doctors merely resort to the one size fits all approach and medicate the disease. Rarely if ever have I read where a doctor investigated why the HA1C was elevated.
This results in a tragic waste of life as well as incurring an enormous and unnecessary expense and suffering.
You may be interested to know that because of the phthalate load, many folks (even without diabetes) unnecessarily get multiple diseases. These can range from Nonalcoholic steatohepatitis or NASH (a common, often “silent” liver disease), heart disease or cancers to Parkinson's disease, arthritis, or Alzheimer's.
Clearly they all lead to accelerated aging because of the shared causes.
For a doctor to check your glycosylated hemoglobin A1C every 3 months yet never know your zinc and B6 levels (among many others) is plain wrong in this sophisticated era.
Your life depends on the decisions you make. This information has a huge bearing on whether your diabetes blinds you in future years.​

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.

References:
Depeint F, et al, Mitochondrial function and toxicity: Role of B vitamins, one-carbon transfer pathways, Chemico-Biological Interactions 163:113-32, 2006
Jain SK, et al, Pyridoxine and pyridoxamine inhibits superoxide radicals and prevents lipid peroxidation, protein glycosylation and (Na+ + K+)-ATPase activity reduction in high glucose-treated human erythrocytes, Free Rad Biol Med 30:232-37, 2001
Onarato JM, et al, Pyridoxamine, an inhibitor of glycation reactions, also inhibits lipid peroxidation reactions, J Biol Chem, 275:21177-84, 2000
Metz TO, et al, Pyridoxamine traps intermediates in lipid peroxidation reactions in vivo: evidence on the role of lipids and chemical modification of protein and development of diabetic complications, J Biol Chem 278:42012-19, 2003
Booth AA, et al, Thiamine pyrophosphate and pyridoxamine inhibit the formation of antigenic advanced glycation endproducts: comparison with aminoguanidine, Biochem Biophys Res Commun, 220:113-19, 1996
Stitt A, et al, The AGE inhibitor pyridoxine and inhibits development of retinopathy in experimental diabetes, Diabetes 51:2826-32, 2000
Laines-Cessac P, et al, Mechanisms of the inhibition of human erythrocyte pyridoxal kinase by drugs, Biochem Pharmacol 54:863-70, 1997


The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com to find practitioners thoroughly trained in functional medicine.

You can't open a magazine these days or watch television without seeing an ad for "the purple pill", Nexium. The original purple pill, Prilosec, was the number one selling prescription drug in 2001.

Both Nexium and Prilosec are what we call proton pump inhibitor (PPI). Prilosec is the original proton pump inhibitor that functions by disabling the protein in your stomach that pumps hydrogen ions (H+ ions) into gastric juices. Basically the PPIs can increase the pH of the stomach from 1 to 5. That means acid production is effectively ceased by these drugs.  

When the patent for prilosec expired, Nexium was introduced with much fanfare. The FDA approval was based on the argument that Nexium was more effective than Prilosec.

Now for the chemistry trivia: Nexium is exactly the same molecule as Prilosec!

To understand the relationship between Nexium and Prilosec let me review a little chemistry. First, prilosec or omeprazole as it is known generically, is a racemic compound. You need to know that many organic molecules come in mirror-pairs. The molecules have exactly the same structure, but are mirror images of each other. Your hands are a good example of this kind of mirror pairing, and in fact the chemical term describing this phenomenon, chirality, comes from the Greek for hand.

That means it is a combination of two chemically identical compounds but one has a different chirality, or handedness, from the other. It just so happens that one of the handed molecules (or as they call it in chemistry, enantiomers) in prilosec is the active drug, and the other enantiomeris inert.

It does nothing.

Amazing isn't it?

That just changing a molecule to its mirror reflection can make it so a drug is effective or totally worthless. 

Again the only active ingredient in Nexium is the exact same thing as the only active ingredient in omeprazole (Prilosec), a (now) generic drug made by the same company, which is over the counter and four to eight times cheaper.

AstraZeneca (the drug company that makes Nexium and Prilosec) just figured out how to purify out the active component from omeprazole.  

Therefore anyone prescribing Nexium is totally missing the basic chemistry of the drug that he is prescribing, because there's absolutely no financial reason to use it.

For pricey Nexium is nothing more than OTC (over-the-counter) Prilosec!

What is the Problem with PPIs?

Both Nexium and Prilosec stop the stomach cells from producing acid needed to digest food, promote nutrient absorption and kill unwanted bugs.

Stopping the pain associated with GERD (Gastroesophageal Reflux Disease) may be a temporary blessing for the one suffering with this condition. But I ask, at what cost to one's overall health?

You see, these drugs act as fertilizer for everyday bugs that then go on to raise havoc. When prescribed for hospitalized patients, they increase pneumonia 30%. Unfortunately, this is what lots of people die from once they end up in the hospital.

PPIs have been found to decrease magnesium in the human body to a point that not even high oral doses of magnesium can correct it.

If you have read any of my past articles you will know that there is overwhelming evidence that magnesium deficiency can create Alzheimer's disease, osteoporosis, high blood pressure, high cholesterol, diabetes, arrhythmias like atrial fibrillation, chronic back spasms mimicking a ruptured disc, depression, seizures, and more.

It is important to mention that Nexium and Prilosec by stopping the acid secretion in your stomach, inhibit the absorption of nutrients that then lead to new diseases, but also then kill the acid needed to fight off fungi like Candida (which can destroy the thyroid gland and heart), as well as bacterial H. pylori overgrowth (that can then create coronary artery plaque and heart attacks).

Worse, acid inhibitors counteract medications like Plavix (clopidogrel) which are prescribed to decrease unwanted clotting. So physicians may be unknowingly propelling the patient toward a heart attack, even though the FDA quietly warned about acid inhibitors canceling out the effects of Plavix years ago.

The goal with all patients is to seek to identify the root cause(s) of the disease entity. The same goes for GERD. There are a number of underlying issues which should be considered when seeking to help patients suffering with GERD. This is the power of functional medicine!

One novel alternative to PPIs is D-Limonene.
http://www.anaturalhealingcenter.com/documents/Thorne/articles/Limonene12-3.pdf

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.
​
References:
Thongon N, et al, Omeprazole decreases magnesium transport across Caco-2 monolayers, World J Gastroent, 17; 12:1574-83, March 28, 2011
Epstein M., et al., Proton-pump inhibitors and hypomagnesemic hyperparathyroidism, New Engl J Med, 355:18 34-36, 2006
Shabajee N, et al, Omeprazole and refractory hypomagnesemia, Brit Med J 337:80 425, 2008
Cundy T, ey al, Severe hypomagnesemia in long-term users of proton-pump inhibitors, Clin Endocrinol (Oxford) 69:338-41,
2008
Broeren MA, et al, Hypo-magnesemia induced by several proton- pump inhibitors, Ann Intern Med 151:755-6, 2009
Durlach j, Magnesium depletion and pathogenesis of Alzheimer's disease, Magnes Res 3:217-18, 1990
Rude RK, et al., Magnesium deficiency and osteoporosis: animal and human observations, J Nutr Biochem 15:710-16, 2004
Touyz RM, Role of magnesium in the pathogenesis of hypertension, Mol Aspects Med 24:107-36, 2003
Ho PM, et at, Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome, J Am Med Assoc 301:937-44, 2009
Sibbing D, et at. Effect of proton pump inhibitors on the antiplatelet effects of ctopidogrel,Thromb Haemost 101:714-9, 2009
Dunn SP. et at, Baseline proton pump inhibitor use is associated with increased cardiovascular events with and without the use of clopidogrel in the CRDEO trial, Circulation 118: S8I5, abst. 2008
Gilard M. et at. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study, J Am Coll Cardiol 51:256-60, 2008
The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com to find practitioners thoroughly trained in functional medicine.

There are only a few natural products that have demonstrated such a wide range of protective properties as curcumin. Turmeric has three main bioactive components, namely curcumin, desmethoxycurcumin and bisdemethoxycurcumin. These curcuminoids have many biological effects including anti-inflammatory, antioxidant, antitumor, antibacterial, and antiviral properties.


According to a study published in Complementary Therapies in Medicine, another application can be added to this list: addressing dyslipidemia in patients with type II diabetes. Researchers demonstrated that curcuminoid supplementation can reduce lipoprotein(a) and increase HDL-C, which may reduce the risk of a cardiovascular event in these patients. 
This study included a total of 82 patients with type II diabetes, 18 to 65 years of age. Each patient took either 1000 mg of standardized curcumin or a placebo for 12 weeks. Baseline lab testing included serum triglycerides, total cholesterol, HDL-C, non-HDL-C, and lipoprotein(a). At the end of the 12 weeks there was a significant reduction of serum lipoprotein(a) and an increase in HDL-C concentrations only seen in the curcuminoid group. There were no significant changes in total cholesterol, LDL-C, and triglycerides in either group.
This is an interesting study since the ability to influence lipoprotein(a) is very limited. Niacin is one of the only natural agents that can significantly reduce lipoprotein(a); however, it is not effective for everyone.
Health care providers have many tools today to assess cardiovascular health and support the body's physiology, and it is essential to perform a thorough assessment of these patients. This may include looking at lipid fractionation profiles, chronic inflammatory markers (ferritin, hs-CRP, fibrinogen), nutrient markers (magnesium, potassium, selenium, copper, folate, B12, B6, zinc, and calcium), fat soluble nutrients (vitamins A, D, E & K, and CoQ10), oxidative stress factors (homocysteine, insulin, and lipid peroxidases), heavy metals, and fatty acid profiles. A successful treatment approach should include investigation into these various factors.

​By: Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

​Source: Panahi Y, Khalili N et al. Curcuminoids modify lipid profile in type 2 diabetes mellitus: A randomized control trial. Complementary Therapies in Medicine. 2017 August;22:1-5.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine. 

Most people have a desire to live life to the fullest with a combination of quantity and quality.
There are many parameters that may determine how long you live, however,this short article presents the findings of five researchers who identified three simple tests you can do at home to measure your ability to increase years to your life.
The medical paper published in the British Medical Journal in 2014 revealed a 13 year study where they took 1,355 men and 1,411 women in 1999 when they were 53 years old and then checked to see who was alive and well 13 year later in 2012.
The following are the three tests that were evaluated:
Standing on one leg with your eyes closed for 10 seconds or longer, having a strong grip, and being able to stand up and sit back down in a chair many times in a minute.
According to the researchers of this paper, these tests clearly represented tell-tale signs of longevity.
Performed well in all three tests at age 53 or so and you should be healthy and vibrant 13 years later, when you are 66.
Researcher from University College London estimate that a 53 year old who can complete these tests successfully is up to 5 times more likely to be alive and well at 66 than someone who couldn't complete the tests or who did them poorly.
There were far higher death rates amoung those who failed to complete the tasks.
Officially the tests are called the Chair Test (Standing up and sitting down in a chair 39 times in a minute for a man, and 36 times for a woman), the balance test (standing on one leg for 10 seconds or longer with eyes closed), and the grip test (ability to apply a pressure of up to 54.5 kg)
To find a healthcare professional certified in functional medicine, go to www.FunctionalMedicineDoctors.com.These are clinicians who have been trained at Functional Medicine University (www.FunctionalMedicineUniversity.com)
​Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., MS

Reference:
Cooper R1, Strand BH, Hardy R, Patel KV, Kuh D.Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study. BMJ. 2014 Apr 29;348:g2219
The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine.