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Tuesday, January 4, 2011

Happy New Year - Important new info from Dr. Saleeby


My main practice web site has changed... have a look at the new pages of  The practice name and location has changed.  New space is shared in a finer, more upscale property downtown Conway.  The name AtroGene will represent the practice as it moves more into the 21st Century reliance on the Internet & Tele-medicine.  Will also be offering best-in-the-industry Online Labs at great cost savings to the consumer.  Access to my active patients to the full line of Xymogen nutraceuticals will be offered to my patients, via the web ( email me for more information.

Today I want to feature a very well written article by Dr. Klein on the relationship between Diabetes and select supplements to deminish the coronary artery disease properties.

JP Saleeby, MD

Diabetes and Atherosclerotic Vascular Disease- Nutraceutical Intervention Update

David S. Klein, MD, FACA, FACPM

Alpha Lipoic Acid: The incidence of type 2 diabetes mellitus (DM) in the U.S.
is already high, and the rate is climbing rapidly. Medical complications seen in
DM patients include coronary heart disease, peripheral vascular disease,
nephropathy, neuropathy and retinopathy. While control of blood sugar levels is
of paramount importance, attention to the sequelae may reduce morbidity and help
reduce healthcare costs.

Pivotal in the development of diabetic complications is dysfunction of vascular
endothelia. Inflammation of the inner lining of the blood vessels results in
platelet aggregation and deposition of cholesterol resulting in atherosclerotic
plaque development. The formation of atherosclerotic plaque is results directly
from endothelial inflammation, often monitored by serum CRP levels.

Recently, it was observed that intravenous alpha lipoic acid (ALA), was found to
be beneficial in patients with DM who suffer from endothelial dysfunction.(1)
Forearm blood flow was measured before and after 21 days of either IV treatment
of 600mg ALA or placebo. Intravenous ALA treatment improves endothelium-dependent
vasodilatation. The investigators also observed that LDL-cholesterol was
reduced in the ALA treatment group.

It was postulated that ALA might improve endothelial function through inhibition
of NF-kappa B and metalloproteinase-9 and upregulation of intracellular adhesion
molecule-1 (ICAM-1).

Alpha Lipoic Acid may also be useful in the treatment of obesity, which is
itself a risk factor for the development of DM. At this time, 34 percent of
adults aged 20 and older are obese; 34 percent are ‘overweight.’
In a recent study, ALA was studied for weight loss in ‘pre-obese’ and obese
adults. Findings of a recent study observing 1,127 men and women between the
ages of 18 and 60 years, observations after measuring the BMI of all
participants, 53 percent were found to be obese and 43 percent were pre-obese.
Study participants were given ALA for 4 months at a dosage of 800mg per day.

The participants experienced After supplementation, investigators found that
participants experienced an 8-9 percent reduction in body weight, a reduction in
BMI by 2-4 points, and a reduction in waist size by 2.5-4 inches.(3)

Resveratrol: Resveratrol is a naturally occurring polyphenol found in the
skin of red grapes and is found in red wine. Thought to offer a range of
beneficial medical effects, Resveratrol is being studied for anti-cancer effects
and for cardiovascular benefits.

Recently, Resveratrol was studied (2) in patients given Resveratrol 40 mg, or
placebo, for six weeks. In the Resveratrol group, there was a significant
reduction in the generation of reactive oxygen species, binding of NF-κB (a
major regulatory component of pro-inflammatory cytokine production), and
expression of JNK-1 and Iκκβ (pro-inflammatory molecules). Study participants in
the Resveratrol group had decreased levels of CRP, TNF-alpha and IL-6 (two major
pro-inflammatory cytokines that are regulated by NF-κB.

According to the authors: “The extract induced a significant reduction in
reactive oxygen species generation, the expression of p47(phox), intranuclear
nuclear factor-kappaB binding, and the expression of jun-N-terminal kinase-1,
inhibitor of kappaB-kinase-beta, phosphotyrosine phosphatase-1B, and suppressor
of cytokine signaling-3 in mononuclear cells when compared with the baseline and
the placebo. PCE intake also suppressed plasma concentrations of TNF-alpha,
IL-6, and C-reactive protein.”

Whey Protein: In a recent study, (4) the effects of supplemental dietary whey
protein was observed in relation to body composition, lipids, insulin and
glucose in comparison to casein and glucose (control) supplementation. In this
12 week study, subjects were randomized to receive whey protein, casein or
glucose supplementation. Seventy men and women, mean ages of 48.4 (SEM 0.86)
years and a mean BMI of 31.3 (SEM 0.8) kg/m2 completed the study. Subjects
supplemented with whey protein had no significant change in body composition or
serum glucose at 12 weeks compared with the control or casein group. Fasting
glucose levels were significantly lowered in the whey group, as compared with
the control group at 6 weeks, and there was a significant decrease in total
cholesterol and LDL cholesterol at week 12 in the whey group as compared with
the casein receiving cadre. Fasting insulin levels were also significantly
decreased in the whey group compared with the control group. Demonstrating that
supplementation with whey proteins improves fasting lipids and insulin levels in
overweight and obese individuals.

Recommendation: Increasing scientific data support the use of Alpha Lipoic Acid
and Resveratrol in the treatment of patients with type II Diabetes. Available
at reasonable cost, these two nutraceuticals are useful in the treatment of a
variety of other conditions, as well, and afford the practitioner an additional
modality to offer patients.
These two nutraceuticals are widely available, but should be used in conjunction
with appropriate diet modification.

1. Heinisch BB, Francesconi M, Mittermayer F, et al: Alpha-lipoic acid improves
vascular endothelial function in patients with type 2 diabetes: a
placebo-controlled randomized trial. Eur J Clin Invest 2010 Feb:40(2):148-54.
2. Ghanim H, Sia CL, Abuayseh S, et al: An antiinflammatory and reactive oxygen
species suppressive effects of an extract of Polygonum cuspidatum containing
Resveratrol. J Clin Endocrinol Metab 2010 Sept;95(9):E1-8. .
3. Carbonelli MG, Di Renzo L, Bigioni M, et al: Alpha-lipoic acid
supplementation: a tool for obesity therapy? Curr Pharm Des. 2010;16(7):840-4.
Pals S, Ellis V & Dhaliwal S: Effects of whey protein isolate on body
composition, lipids, insulin and glucose in overweight and obese individuals. Br
J Nutr. 2010 Sept; 104(5):716-23.

David S. Klein, MD has practiced pain medicine for the past 27 years and is the author of over 50 published articles and textbook chapters.  His writings have appeared in this blog previously.

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