Nutritional Testing...Vitamin D from sun or food is hydroxylated in liver to form 25-hydroxyvitamin...

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Nutritional Testing For Nutrition Optimization and Disease Prevention For The School of Applied Functional Medicine™ Presented by: Kirstin Keilty, MS, CNS

Transcript of Nutritional Testing...Vitamin D from sun or food is hydroxylated in liver to form 25-hydroxyvitamin...

  • Nutritional TestingFor Nutrition Optimization and Disease Prevention

    For The School of Applied Functional Medicine™

    Presented by: Kirstin Keilty, MS, CNS

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    Dietary intake

    Absorption

    Transport

    Storage Activation

    Receptors

    Inhibition

    Metabolism Excretion

    Hormonal Status

    Genetic Influences

    Disease

    Lifestyle Factors

    Pharmaceuticals

    Gender

    Ethnicity

    Pregnancy

    Exercise

    Tobacco & AlcoholAge

    Many factors affect nutrient status

  • Obesity Epidemic in America In 1900, the average male weighed 133 lbs, the average

    female 122 lbs. In 2000, the average male weighed 166 lbs, the average

    female 144 lbs.

    In 2015 4 states have populations where 35% of the population exceed a BMI of 30, 21 states have population were 30%+ exceed BMI of 30, 19 states have population where 25% + exceed BMI of 30, 7 states have population 20%+ exceed BMI of 30.

  • NHANES III “Many Americans are exceeding energy (caloric) requirements but

    not meeting micronutrient recommendations, presumably due to excessive consumption of energy-dense, nutrient-poor foods. Indeed, data from NHANES found that energy-dense, nutrient-poor foods comprise 27% of daily caloric intake in the American diet, and alcohol constituted an additional 4% of daily caloric intake. This survey also found that higher intakes of energy-dense, nt-poor foods were associated with lower serum concentrations of several micronutrients, including vitamin A, folate, vitamin B12, vitamin C, and vitamin E. “

    Kant AK. Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional andhealth implications. The third National Health and Nutrition Examination Survey, 1988-1994. AmClin Nutr. 2000;72(4):929-936.

  • A word about nutrition standards EAR – Estimated Average Requirement – set by scientists

    – if intake is below that you are said to be inadequate (deficient)

    RDA – Recommended Dietary Allowance - 2 SD above the EAR

    American population is below the EAR! Vit K 35%, vit D 70%, Vit E 60%, Mg 45%, Ca 38%, Vit A

    34%, Vit C 25%, Zinc 8 %, B6 8%, Folates 8%

  • “Rates of weight counseling in primary care have significantly declined despite increased rates of overweight and obesity in the United States. Further, these declines are even more marked in patients with obesity and weight-related comorbidities, despite expectations to provide such care by both patients and policymakers. These findings have implications for determining deliverable, novel ways to engage PCPs in addressing the obesity epidemic.”

    Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care. 2013;51(2):186-192.

  • Physicians' direct discussion of their patients' weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients' weight status leads to significant weight loss.

    Pool AC, Kraschnewski JL, Cover LA, et al. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. 2014;8(2):e131-139.

  • Nutrition is the low hanging fruit for disease prevention

  • Bruce Ames, PhDDr Bruce Ames is Professor of Biochemistry and Molecular Biology, University of California, Berkeley, and a Senior Scientist at Children’s Hospital Oakland Research Institute (CHORI). The importance of Dr Ames’ scientific experience and contributions, spans generations, having published in over 500 scientific journals, and gained long lists of honours and awards.

  • Bruce N. Ames, PhDLow micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage.

    Contributed by Bruce N. Ames, October 6, 2006 (received for review September 20, 2006)

  • Applying ”Triage” To NutritionTriage Theory Definition

    Bruce Ames, PhD – UC Berkley

    DNA damage and late onset disease are consequences of a 'triage allocation mechanism' developed during evolution to cope with periods of micronutrient shortage. In other words, micronutrients, when scarce, are used for short-term survival at the expense of long-term survival.

    Triage allocation mechanisms – Your bodies’ innate response to ensure survival of TODAY depends on its ability to allocate, or choose, which functions of the body it must MOST support given the supplies with which it is provided (Dietary and supplemental ingestion).

  • Health to Disease

  • Why would nature do this? Natural selection seeks to keep us alive to mature enough

    to reproduce. Nature is not as worried about your long life to 90 years

    of age. There is a specific type of “rationing” of nutrients when a

    nutrient becomes insufficient (not just deficient) so that the body “allocates” the most important proteins to those processes in the body that are most important to short-term survival.

    Proteins (enzymes) that are more pertinent to long-term survival are shorted, and this causes insidious damage

  • Measures Intracellular status of 31 important micronutrients and 4 biomarkers

  • Technology Summary

    Day 1Isolation of

    Lymphocytes Long term nutritional marker

    Day 1

    Incubation & Growth in defined culture

    mediaPatent technology 15 yrs developed at U.T. Austin

    Days 2 – 3

    Mitogen stimulation & growth

    Vary components growth dependent on intracellular

    levels

    Day 43H Thymidine incorporation 200 growth measurements

    Day 5Growth response

    measurementDeficiency, transport, and metabolic requirements

    Sheet1

    Day 1Isolation of LymphocytesLong term nutritional marker

    Day 1Incubation & Growth in defined culture mediaPatent technology 15 yrs developed at U.T. Austin

    Days 2 – 3Mitogen stimulation & growthVary components growth dependent on intracellular levels

    Day 43H Thymidine incorporation200 growth measurements

    Day 5Growth response measurementDeficiency, transport, and metabolic requirements

    Sheet2

    Sheet3

  • Why use lymphocytes? Lymphocytes provide a

    long term nutritional marker

    Contain a genetic marker (nucleated cell)

    Closely tied with immune function

    Representative of overall health

  • Putting it into practice

    Nutrition is a concert, not a solo, the Micronutrient testing puts you and the

    patient in the conductor’s seat, via results that are measurable and

    ACTIONABLE

  • Vitamin K Vitamin K dependent proteins are present in liver and pancreas to

    help metabolize glucose Cofactor in the formation of glycogen from glucose Cofactor to carboxylase enzyme that converts glutamic acid to γ-

    carboxyglutamic acid (Gla protein) which creates calcium binding sites on proteins by modifying its three dimensional shape and inducing a functional transformation

    To date, 14 vitamin K dependent proteins have been clearly identified Poor vitamin K status linked to excess fat tissue May reduce progression of insulin resistance Inhibits estrogen activity by binding to the estrogen receptor 17β-

    hydroxysteroid dehydrogenase 4 Lowers the ratio of estradiol (strong estrogen) to estrone (weaker

    estrogen) Deficiency reduces testosterone production Rate limiting enzyme for testosterone synthesis (Cyp11a) is vitamin K

    dependent Down regulates pro-inflammatory cytokines Influences gene expression by binding with the steroid and xenobiotic

    receptors Formation of osteoclasts (bone cells) is vitamin K dependent Increases bone mineral density Cofactor to osteocalcin (also called bone Gla protein), which is

    needed for bone mineralization Cofactor for six proteins that regulate blood clotting, including Factor

    II (prothrombin), VII, IX and X Cofactor to protein C, an anti-coagulant that regulates blood vessel

    permeability and inflammation Cofactor to protein S, a protein that regulates cell death (apoptosis)

    and anti-coagulation Cofactor to protein Z, which enhances the action of thrombin

    (activated form of prothrombin)

    Cofactor to matrix Gla protein (MGP) which is a coronary artery calcification inhibitor

    Cofactor to periostin, a protein that occurs in collagen rich connective tissue, including bone

    Cofactor to Gas6 (growth arrest-specific gene 6) protein, which regulates cell death (apoptosis), inflammation, and cell to cell signaling

    Inhibits arterial calcification, especially in those taking vitamin D which increases calcium absorption

    Helps prevent lipid peroxidation and arterial plaque progression Can regulate gene activity Excess vitamin K will not adversely affect clotting factors Inhibits growth of cancerous tumors in various tissues (liver, colon,

    lung, stomach, bone, leukemia) Lowers risk of prostate cancer due to its role in osteocalcin

    (undercarboxylated osteocalcin is linked to prostate cancer and inversely related to vitamin K

    status) Animal studies suggest vitamin K deficiency causes behavioral changes

    and general malaise Antibiotics can induce vitamin K deficiency Cephalosporins and salicylates decrease vitamin K by inhibiting the

    enzyme (eopxide reductase) that recycles it Anticoagulants (Coumadin and warfarin) create a functional vitamin K

    deficiency but supplementation should be done with caution for those on blood thinners since oversupplementing with vitamin K will nullify the effects of these drugs

    Three forms of vitamin K exist: K1 (phylloquinone) found in plants, K2 (menaquinone) that is synthesized in the intestines and K3 (menadione), a synthetic form activated in the liver

    Supplementation of K1 is recommended as it is the precursor for K2 K2 (in the form of MK-7) is the most beneficial for bone health Very little vitamin K is stored in the body so the vitamin K recycling

    process is crucial Vitamin D and K have synergistic effects on bone health

  • Vitamin D Prohormone that is synthesized in the skin from 7-dehydrocholesterol via

    sunlight Vitamin D from sun or food is hydroxylated in liver to form 25-

    hydroxyvitamin D3 (calcidiol) which is hydroxylated again to form 1,25-dihydroxyvitamin D3 (calcitriol)

    Deficiency causes increase in parathyroid hormone, which pulls calcium (Ca+) ions into blood by stimulating the 1-hydroxylase enzyme in the kidney to increase calcitriol production

    Active form (calcitriol) may increase absorption of calcium and magnesium in intestines

    Regulates calcium homeostatis in body via complex system called vitamin D endocrine system

    Regulates synthesis of osteocalcin by osteoclasts (bone cells) Inhibits lipid peroxidation Anti-carcinogenic properties include programmed cell death (apoptosis)

    for cancerous cells Most cells have vitamin D receptors that alter how nucleus codes for

    genes, thus altering cell function Shuts off chronic inflammatory responses Over 200 genes are regulated by vitamin D At least 35 tissues have vitamin D receptors Regulates expression of cholesterol metabolism gene Lrp5, (low density

    lipoprotein receptor protein 5) Regulates expression of genes (p21 and p27) that control cellular

    proliferation and differentiation Prevents angiogenesis (blood supply to cancerous tumor cells) Lowers pro-inflammatory TNF-α (tumor necrosis factor alpha) Raises anti-inflammatory cytokine IL-10 (interleukin-10) Vitamin D receptors exist in pancreas to regulate blood levels of insulin Enhances secretion and action of insulin Affects genes that alter adipocyte differentiation (the way fat cells form) in

    some people Supresses inflammation of pancreatic beta cells

    Suppresses foam cell formation in arteries thus reducing risk of blood vessel blockages

    Decreases expression of a gene that codes for renin, an enzyme that increases blood pressure

    Low levels can alter expression of genes that induce anxiety or depression Low levels reduce lung capacity in asthmatics and increase severity of asthma

    attacks Low levels in mother increase risk of autism in child High dose vitamin D can reverse autistic behaviors in children Increases E-cadherin expression (protein that prohibits cancer cells from

    metastasizing) Low levels cause reduced muscle strength, impair neuromuscular function and

    increase myalgias Low levels linked to hypertension due to its role in calcium transport Higher levels correlate to longer telomeres Higher levels linked to better success rates of IVF (in vitro fertilization) Increases sperm motility Regulates production of estradiol, estrone, progesterone and testosterone Increases total, free and bioactive testosterone levels Enhances estrogen’s protective effect on bone Increases expression of tyrosine hydroxylase gene, which synthesizes dopamine Regulates immune response by interacting with vitamin D receptors on T cells

    (lymphocytes) Modulates T cell response, such that autoimmune responses are diminished (type 1

    diabetes, multiple sclerosis, arthritis) but innate immunity is enhanced Regulates gene that makes cathelicidin, an anti-microbial protein that protects

    against pathogens Regulates several genes that control smooth muscle cell growth (blood vessel

    lining), endothelial function, thrombus formation and fibrinolysis (a process that dissolves blood clots)

    10-15 minutes of midday sun exposure on upper body (most vitamin D receptors in skin are on arms, neck, shoulders and face) gives 10,000 IU. No risk of vitamin D toxicity exists from sun exposure because excess vitamin D from UV light is safely metabolized into benign form.

  • Interpreting the MNT is as easy as…..1. View and assess the Immunidex and Spectrox. 2. View and assess the insufficiencies as well as the

    magnitude of the insufficiency (review the functions of these nutrients/biomarkers).

    3. View and assess the borderline and “trending” nutrients (review the function of these nutrients/biomarkers).

    4. Connect the intersections with patient symptoms.

  • 46 year old male Traditional dentist Making a transition to healthier diet Eats ”relatively” well 6-8 servings of vegetables? (No – 2-3 per day) Some etoh – 2-3 times a week 1-2 cups caffeinated coffee most days Has 20-25 lbs to loose/mostly belly area Exercises 2-3 days a week running/biking/walking (sometimes when he

    can) No supplements or meds currently – Tums for occasional heartburn Family history of heart disease and diabetes both sides

  • Creating the Nutritional Scoresheet

  • KEY

  • SpectroxTM & Immunidex

  • Immunidex TM

    Measures T-cell lymphocyte proliferation Since immune function is a systemic measure of

    general health, a higher Immunidex™ score is generally desired since it means a person can respond efficiently not only to exogenous threats such as pathogens or allergens, but also to endogenous threats such as malignancies (& inflammation).

    The reported Immunidex™ score is used to evaluate a person’s cell-mediated immune system performance.

  • SPECTROX TM

    SpectroxTM assesses the ability of cells to resist damage caused by free radicals and other forms of oxidative stress

    Due to the considerable number of cellular antioxidants with extensive interactions, redundancies, repair and recharging capabilities, measuring total function is the most accurate and clinically useful way to assess your patients’capacity to resist oxidative damage.

  • Step 1 Longevity ”sweat spot” is in improving immune system

  • Nutritional ScoresheetBorderlinesImmunidexSpectrox

  • Step 2

  • STEP 2

    Magnitude of deficiency

    Important for retest in 6 months

    should be >54%Is 51% = -3

    should be >50%Is 43 -7Should be >30%Is 29% - 1Should be >37%is 32% -5

    Should be >38%Is 36% -2

    4th pg of results

    Consider function of the nutrient or biomarker

  • Nutritional ScoresheetSubclinical DeficienciesB6: - 3Vit D: - 7Vit K2: -1Zinc: -5Glucose/Insulin Interaction: - 2

    BorderlinesImmunidexSpectrox

  • Functions of insufficient analytes B6 - neurotransmitter production, works with Mg,

    MTHFR reduction Vit D – near 1,000 different processes in body, increase

    serotonin production through THP I and II regaulation, breast and colon cancer, bone health

    Vit K2 - anti-clotting and thrombosis health, bones Zinc - bone health, MTHFR, immune health Glucose/Insulin Interaction – How well the insulin

    receptor handles glucose: B3, biotin, inositol, vit D, Vit A, Vit K, Mg, Zn, Ca, Mg, Mn, Ch

  • Step 3Borderline &“Trending” values

  • Consider B-Complex?

    Gut issues?

    Absorption?

    Glutamine –preferred source of fuel for gut

    Homocysteine

    MTHFR?

    Marker of fatty acid oxidation

    Helpful for absorbing fat soluble vites

    Cardiac function, muscle contractility, MTHFR

    MTHFR mutation, DNA repair, NTD prevention

  • HFCS consumption, sucrose, honey/dates, FODMAPs

    Chromium potentiates action of insulin uptake, along with Zn, Mg, Vit D & K, biotin, B3, inositol

    CoQ10 mitochondrial nutrient along with biotin, zinc (SOD), B3. Lipid regulation

  • Nutritional ScoresheetSubclinical DeficienciesB6: - 3Vit D: - 7Vit K2: -1Zinc: -5Glucose/Insulin Interaction: - 2

    BorderlinesImmunidexSpectroxFolateBiotinGlutamineOleic acidCoQ10

  • Stress, CoA, Acetyl-CoA

    GABA precursor, blood sugar balance

    MTHFR, nervous systemWorks with

    chromium for blood sugar balancing, reduces cholesterol

  • Nutritional ScoresheetSubclinical DeficienciesB6: - 3Vit D: - 7Vit K2: -1Zinc: -5Glucose/Insulin Interaction: - 2

    Borderlines “Trending”Folate B3Biotin B12Glutamine PantoOleic acid InositolSpectroxCoQ10Immunidex

  • Connecting Intersections and Sx Cardiovascular/MTHFR – B6, D3, K2, Zinc, G/I

    Interaction, Glutamine, oleic acid, Mg, Spectrox, CoQ10, B3, B12

    Gut- weak presentation of B-complex (aside from B1 and B2), biotin (made in gut along with K2) L-Glutamine, Zinc, oleic acid, vit D, fructose sensitivity

    Disglycemia – Vit D, K2, zinc, G/I Interaction, biotin, Mg, Chromium, B3, inositol

  • Bio-Nutritional PlanDiet (mainly for his borderline and trending values) Increase broad spectrum of veggies, 6-8 servings, if not possible, add

    superfoods powder and/or full-spectrum antioxidant formula (increase K2, biotin, fructose sensitivity helping with bacterial fermentation/increase good guys) increase folate, Spectrox, Immunidex.

    Oranges and Cantaloupe contain good amounts of myo-inositol Increase green leafy veg (Mg is at the center of the chlorophyll

    molecule) Increase fermented foods (sauerkraut/kimchi) if not, increase cabbage

    for glutamine Chromium is found in good amount through broccoli/steel cut oats

    (animal protein/bone broth) Increase EVOO (good quality) unheated to 1 TBSP per day (in

    addition to what you may saute with)

  • Supplementation Short List High VitD/K2 combo Zinc-carnosine or (carnosine/monomethionine complex) B-Complex (look for methylated/adenosyl/hydroxo

    formulas) – should also contain panto, inositol, biotin

  • Additional Supps if Food Non-Compliant

    Probiotic/Glutamine combo CoQ10/Mg combo 200 mcg Chromium Antioxidant complex/Superfoods powder

  • Contact Us

    For more information about Spectracell and how to receive a discounted Micronutrient

    test for yourself, please contact us at: 800-227-5227, ext. 5

    Slide Number 1Slide Number 2Obesity Epidemic in AmericaNHANES IIIA word about nutrition standardsSlide Number 6Slide Number 7Nutrition is the low hanging fruit for disease preventionBruce Ames, PhDBruce N. Ames, PhDApplying ”Triage” To NutritionHealth to DiseaseWhy would nature do this?Measures Intracellular status of �31 important micronutrients and 4 biomarkersTechnology SummaryWhy use lymphocytes?Putting it into practiceSlide Number 18Vitamin KVitamin DInterpreting the MNT is as easy as…..46 year old maleSlide Number 23KEYSpectroxTM & ImmunidexImmunidex TM SPECTROX TMSlide Number 28Nutritional ScoresheetSlide Number 30Slide Number 31Nutritional ScoresheetFunctions of insufficient analytesSlide Number 34Slide Number 35Slide Number 36Nutritional ScoresheetSlide Number 38Nutritional ScoresheetConnecting Intersections and SxBio-Nutritional PlanSupplementation Short ListAdditional Supps if Food Non-CompliantContact Us