GLUCOSE REGULATION. Diabetes in the Elderly. Focus on Elements: Glucose. Nutritional Needs for the Elderly March 26, Tracey C.

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1 31 st Annual MVGC Conference The Changing Faces in Elder Care March 26, 2010 NUTRITIONAL NEEDS FOR THE ELDERLY SESSION 2 GLUCOSE REGULATION Hemoglobin A1C, Serum Glucose, Triglycerides Diabetes in the Elderly According to the American Diabetes Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes. The prevalence of the disease increases with age An estimated 50% of all diabetes happens in those aged 55 and older. Older Americans are also more likely to have complicating conditions such as retinopathy, hypertension, and renal problems. Focus on Elements: Glucose Healthy range: 70-90mg/dL. Clinical range: 65-99mg/dL CRITICAL RANGE: less than 40mg/dL and over 450mg/dL. DECREASED in: Hypoglycemia Hypothyroidism Early diabetes Neuroglycopenia (lack of glucose to brain) Insulinomas (pancreatic islet cell tumors) Pancreatitis Hepatitis Glucagon deficiency Liver disease Cancer Addison s disease (adrenal insufficiency) Hypopituitarism (deficiency of ACTH or growth hormone) Hypothalamic lesions Malabsorption Starvation/fasting Alcoholics Amino acid defects Fatty acid metabolism defects Carnitine deficiencies Drugs: Insulin Oral hypoglycemic drugs Alcohol Salicylates Quinine Haloperidol Nutrients to consider: Chromium Picolinate, Zinc, Vanadium (check hair level) Diabetic or Hypoglycemic diet Focus on Elements: Glucose INCREASED in: Poor carbohydrate metabolism Diabetes type I and II Nonfasting specimen Stress Myocardial infarct Brain damage CVA Convulsions Cushing s disease Acromegaly and gigantism (with insulinresistant diabetes, Hypopituitarism later) Tumors Liver disease Pancreatitis Vitamin B1 deficiency Hypervitaminosis A Drugs: Alcohol Estrogens Corticosteroids Phenytoin Propranolol Thiazide Diuretics Corticoids Oral contraceptives Thyroid hormone Progestins Anti-inflammatory drugs Diuretic and Antihypertensive drugs (Thiazides, Furosemide, Clonidine) Neuroactive drugs (Phenothiazines, Tricyclics, Lithium carbonate, Haloperidol) Adrenergic agonists (Isoniazid, Heparin, Cimetidine, Nicotinic acid) Nutrients to consider: Chromium; Zinc; Vanadium (check hair level); Diabetic or hypoglycemic diet depending on level of glucose. Focus on Elements: Glycohemoglobin A 1C A low value may precede diabetes due to hyperinsulinism. Healthy range % Clinical range % CRITICAL VALUE: over 10.1%. Hemoglobin A 1C gives a average glucose over 2-3 months. DECREASED in: Hypoglycemia Hemolytic anemias Congenital diseases Blood loss: acute or chronic Pregnancy Kidney disease with or without Hemodialysis Low protein INCREASED in: Poor glucose control Retinopathy Diabetes mellitus Diabetic neuropathy Pregnancy Iron deficiency anemia Splenectomy Increased serum triglycerides Alcohol Albuminuria Hemochromatosis Environmental: Lead toxicity 1

2 Focus on Elements: Triglycerides Clinical range mg/dL Healthy range mg.dl 95% of tissue storage fat is triglycerides. Diabetes: supporting values DECREASED in Proteinemia Malnutrition Recent weight loss Vigorous exercise Hyperthyroidism Drugs: Vitamin C Alpha1 receptor blockers Phenformin Clofibrate Asparaginase Progestins Metformin Aminosalicylic acid INCREASED in High carbohydrate diet Family trait Liver disease Kidney disease Hypothyroidism Diabetes mellitus Alcoholism Gout Pancreatitis Acute myocardial infarction Acute illness (cold, flu etc.) Pregnancy Obesity Drugs: Oral contraceptives Estrogens Beta-blockers Hydrochlorothiazide Anabolic steroids Corticosteroids Thiazide Diuretics Amiodarone Interferon Nutrients to consider: chromium, vanadium and a low carbohydrate diet low HDL high LDL high Uric Acid high Sodium low Potassium low chloride high and low magnesium high and low phosphorus low protein high A/G ratio low iron high ferritin high alkaline phosphorus high LDH low SGOT high SGPT high GGT high cholesterol high triglycerides high WBC low polys low hair chromium low hair vanadium Nutrients to consider: chromium, vanadium Pg. 52 Nutrients that affect glucose regulation Diabetic Dosage Primary All diabetics should be on these nutrients Vit C Vit E Magnesium EPA/DHA Secondary Chromium Picolinate/GTF Vanadium Niacinamide Fenugreek Gymnema Sylvestre Bitter Melon Cinnamon Nutrient lbs lbs Over 190lbs Vitamin C 2000mg 4000mg 6000mg Vitamin E 200IU 400IU 800IU Mg 200mg 300mg 400mg EPA/DHA 250mg 500mg 1000mg Carbohydrates 40-60% of your meal needs to be carbohydrate. Most desirable carbohydrates sources: whole grain breads, pastas (including egg noodles), and rice, whole vegetables, whole fruits Least desirable carbohydrates: anything made with white sugar and/or white flour, fruit juice, high fructose corn syrup, chips, french fries, pop CARBOHYDRATES 2

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4 Category 1 Diabetic Category 2 Diabetic Category 1- Vegetables: Fresh or Frozen Most Desirable Vegetables with lowest carbohydrate content) Asparagus Avocado Bean sprouts Beans, string Beet greens Broccoli Brussels Sprouts Cabbage Carrots Cauliflower Celery Chard, Swiss Collards Cucumber Dandelion Greens Eggplant Endive Kale Kohlrabi Leeks Lettuce Mushrooms Mustard Greens Okra Onions Parsley Peppers, any Pimento Pumpkin Radishes Rutabagas Sauerkraut Spinach Squash Tomatoes Turnips Water Cress Category 2 Hgb A1C 6-8 UA Glucose mg/dl Category 2- Vegetables: Fresh or Frozen (higher carbohydrate content) For a change, twice weekly, they may choose one vegetable from this list. Artichokes Beans, dried Beans, kidney Beans, Lima Corn Hominy Parsnips Peas, green Potato, sweet Potato, white Rice Yams Category 2- Fruits: Fresh or Frozen (Less Desirable Fruit with higher carbohydrate content) As glucose becomes more regulated, more choices may be made from this list when given permission based upon test results. Apple Apricots Betty Lou Smackers Blackberries Cranberries Currants Grapes Gooseberries Grapefruit Guava Melons Lemons Limes Oranges Papayas Peaches Plums Raspberries Tangerines Pg. 41 Category 3 Diabetic Category 3 Hgb A1C <6 UA Glucose <100mg/dl Category 3- Fruits: Fresh or Frozen (Least Desirable Fruit with highest carbohydrate content) Use these only when glucose had normalized and permission is given to choose from this list based upon test results. Bananas Blueberries Cherries Figs Kumquats Loganberries Mangoes Mulberries Pears Pineapple Pomegranates Prunes Note: All vegetables should be eaten raw or lightly blanched or steamed (cook until color is vibrant). If the client has digestive problems, it is advised to always blanch or steam vegetables before eating. Patient: Case Presented 8/14/2001 Age: 61 Weight: 203lbs Presented with: Diabetes Glucose-309 Hgb-A1C-11.8 Ferritin- 412 Cholesterol- 269 Diverticulosis Extreme Fatigue Medications Glucophage (for diabetes, for 1 week) Bacterim (for a yeast infection, for 2 weeks) Diflucan (for a yeast infection, for 2 weeks) Case: Case20474 Presented 8/14/2001 Age: 61 Weight: 203lbs Diabetes; fatigue; increased liver enzymes; yeast infection; her vision has been getting worse recently; decreased appetite; had canker sores in the spring with a lot of stress, decreased memory and concentration; is very tired; has diarrhea, which was worse while on Glucophage; hair is dry and coarse; has pain in the abdomen; has a coated tongue. Diabetes treated with Glucophage Glucophage caused side effects of diarrhea and other significant gastrointestinal problems Yeast infections treated with Bacterim and Diflucan Case: Case20474 Summary of Test Findings High Glucose (309) Hemoglobin A1C at 11.8 High Liver Enzymes High Ferritin at 412 Cholesterol of 269 Possible Infection Very High Heavy Metals (aluminum, cadmium, bismuth) 4

5 Case: Case20474 Test Results and Nutritional Recommendations Hyperlipidemia Recommendations: Chromium Picolinate w/ Boron, EPA/DHA Diabetes Recommendations: Category 1 Diabetic Diet, Chromium Picolinate w/ Boron, Glucoril, EPA/DHA, Niacinamide, Vanadyl Sulfate Inflammation of the Liver: Recommendations: Beta Carotene, Liver [glandular, Key Co], Lauricidin, Powdered Vit C Case: Case20474 Test Results and Nutritional Recommendations Possible Hemochromatosis Possible Allergy, Reactivity or toxicity Possible Immune Deficiency, Allergy or Infection Recommendations: Lauricidin, Powdered Vit C Other nutrients recommend: Calcium, Chlorella, Vit E w/ selenium; Acidophilus, Magnesium Glycinate, Multiple Mineral; Vitamin B6; Zinc Personal Vitamin and Supplement Program For: 2 Month Monday, June 14, 2004 Case Test Supply Vitamin or Supplement Dosage Per Day AM NOON PM BED Bottles Quantity Price Extended Price 1 Beta Carotene ( A-Caro, Key Company) I.U. 1 1 $18.20 $ Acidophilus (Lacto-Key, Key Company) $8.70 $ Calcium MCHC (Douglas Labs) 2000 mg $27.55 $ Chlorella Plus (Douglas Labs) 1500 mg $13.20 $ Chromium Picolinate w/ boron (Douglas Labs) 500 mcg $9.30 $ Vitamin E-400 w/ selenium (Douglas Labs) 400 I.U. 1 1 $15.75 $15.75 Case: Blood Analysis Comparison August 2001 to November Glucoril (Phyto Pharmica) $14.90 $ Liver (Key Company) 1500 mg $9.40 $ Magnesium Glycinate (Douglas Labs) 300 mg $28.15 $ MLK EPA/DHA (The Key Company) 3000 mg. 3 2 $9.30 $ Niacinamide (Key Company) 500 mg. 1 1 $6.60 $ Norwegian Kelp (Key Company) 1500 mg $9.90 $ Spectramin Chelate (Douglas Labs) 900 mg $8.55 $ Vanadium 250 (Douglas Labs) 500 mcg $9.75 $ Vitamin B6 (Key Company) 500 mg. 1 1 $18.20 $ Zinc (Key Company) 50 mg. 1 1 $7.85 $ Lauricidin (Med-Chem Labs) Take 5 ¼ teaspoons/day $32.50 $ Powdered Vitamin C (Ascorbic Acid, Key Company) Take 10,00 mg/day for 2 weeks 1 $18.80 $ Vitamin C Douglas Labs Natural C 3000 mg Start after 2 weeks Supplements Must Be Paid In Full Upon Receipt Take All Supplements With Meals Unless Otherwise Noted Speciality / Instructions Sub Total $ Tax $28.09 Total $ Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l 5

6 Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l Test #1 8/14/2001 Findings: Hyperlipidemia, Diabetes, Inflammation of the Liver, Anemia, Possible Hemochromatosis, Possible allergy, reactivity or toxicity, Possible Immune Deficiency, Allergy or Infection, Possible Infection and/or Inflammation Recommendations: Category 1 Diabetic Diet, Beta Carotene, Calcium, Chlorella, Chromium Picolinate w/ Boron, Vit. E w/ Selenium, Glucoril, Lacto Key, Liver, Magnesium Glycinate, MLK 1000, Lauricidin, Niacinamide, Powdered Vit. C, Selenium, Spectramin Chelate, Vanadyl Sulfate, Vit. B6, Zinc Current Current Test Description Result Rating Healthy Clinical Units Date 8/14/01 Glucose HI mg/dl Hemoglobin A1C(Gly-Hgh) HI % Uric Acid 3.90 lo mg/dl Blood Urea Nitrogen (BUN) Opt mg/dl Creatinine 1.00 Opt mg/dl BUN / Creatinine Ratio Opt ratio Sodium LO meq/dl Potassium 4.60 Opt meq/dl Chloride Opt meq/dl Magnesium 2.00 lo mg/dl Calcium 9.80 Opt mg/dl Phosphorus 3.40 Opt mg/dl Calcium / Albumin Ratio 2.33 Opt ratio Total Protein 7.60 Opt gm/dl Albumin 4.20 Opt gm/dl Globulin 3.40 Opt gm/dl A / G Ratio 1.20 Opt ratio Total Bilirubin 0.60 Opt mg/dl Alkaline Phospatase hi mu/ml LDH hi mu/ml SGOT (AST) HI mu/ml SGPT (ALT) HI mu/ml GGT hi mu/ml Serium Iron lo mcg/dl Ferritin HI ng/ml Cholesterol HI mg/dl Triglyceride HI mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL HI mg/dl Total Cholesterol / HDL Ratio 6.20 HI ratio T Opt mcg/dl T Opt % T Opt White Blood Count 4.70 LO k/cumm Red Blood Count 4.69 Opt m/cumm Hemoglobin Opt gm/dl Hematocrit Opt % MCV Opt cu.m MCH hi pg MCHC hi % Platelets Opt k/cumm Polys (SEGS-PMNS) LO % Lymphocytes HI % Monocytes 7.00 Opt % Eosinophils 5.00 hi % Basophils 1.00 hi % Erythrocytes Sed Rate ESR 9.00 hi mm/hr CRP C-Reactive Protein 6.70 HI mg /L Creatine Kinase Opt u/l Patient Comments Lost 30lbs Walking 5 days a week Lots more energy Eyes bright, very excited about program Current Current Prior Test Description Result Rating Result Delta Homeostatic Clinical Units 08/14/01 DATE 11/20/01 Glucose hi mg/dl Hemoglobin 6.10 hi % A1C(Gly-Hgh) SGOT (AST) Opt mu/ml SGPT (ALT) Opt mu/ml GGT Opt mu/ml Serium Iron LO mcg/dl Ferritin hi ng/ml Cholesterol HI mg/dl Triglyceride hi mg/dl HDL Cholesterol lo mg/dl LDL Cholesterol HI mg/dl VLDL hi mg/dl Total Cholesterol 5.90 HI ratio / HDL Ratio Pg. 41 Pg

7 CALCIUM HEALTHY RANGE MG/DL CLINICAL RANGE MG/DL CRITICAL RANGE: <6MG/DL & >14 MG/DL. GENERAL MALNUTRITION BEST FOOD SOURCES SEAWEEDS SUCH AS KELP, WAKAME NUTS AND SEEDS (LIKE ALMONDS AND SESAME); BLACKSTRAP MOLASSES; BEANS; ORANGES; FIGS; QUINOA; AMARANTH; COLLARD GREENS; OKRA; RUTABAGA; BROCCOLI; DANDELION LEAVES; KALE Calcium Decreased In: Factors that contribute to Ca loss Calcium deficiency Poor digestion Vit D deficiency Diarrhea Malnutrition Sprue Celiac disease High phosphorus Kidney disease Malnutrition Low magnesium Hypoparathyroidism Rickets Osteomalacia check for a clinically high alkaline phosphatase Pancreatitis Bacteremia Nutrients to consider Calcium Vitamin D Magnesium Aspirin NSAIDS Steroids Inhalers!! Study: 200 women who used steroid-based inhalers for an average of 6 years to treat mild asthma. Bone loss is 5x greater than someone smoking a pack of cigarettes daily for 10 years! Most rapid bone loss occurred in the first 2 years Lancet, April 22, 2000 Tetracycline an antibiotic Protein pump inhibitors (PPIs) Prevacid Nexium Antacids that contain aluminum Alcohol Tobacco Caffeine Barbiturates Caffeine Connection Caffeine the urinary excretion of Ca, Mg, Na & Cl for at least 3 hrs after consumption Interferes w/ the absorption of Vitamin D Where is caffeine? Energy drinks, over the counter pain medications, ice cream, hot cocoa, chocolate candy, coffee drinks and soda pop Mt Dew has 71mg in 12oz Stomach Acidity The absorption of calcium is in part dependant upon ionization in the intestines. The most commonly used form of calcium supplementation is calcium carbonate which must first be solubilized and ionized by stomach acid. Those with low stomach acid production will obviously have a harder time with this form of calcium. It s been shown those with low stomach acid may only absorb 4% of an oral dose of calcium carbonate where as those with normal stomach acid can absorb 22%. Calcium citrate, lactate or gluconate are the better forms of calcium supplementation to use. Upwards of 45% of calcium lactate can be absorbed even in those with low stomach acid. 7

8 Calcium How much Calcium in that bottle? MCHC Microcrystalline Calcium Hydroxyapatite Compound Lactate Citrate Nutrient lbs lbs Over 190lbs Calcium 500mg 750mg 1000mg Calcium needs help! Vitamin K: found in green leafy vegetables. Osteocalcin (a protein found in bone) anchors calcium to hold it in place within the bone structure. Vitamin K has a primary role in converting the inactive form of osteocalcin into it s active form. Environment Cadmium causes calcium loss within hours of exposure. Bone is a long term storage site for lead that cannot be excreted. Lead and calcium have the same transport sites for absorption and transportation within the body. Lead also has a direct (affects the way bone cells tear down and build bone) and indirect (kidney function) influence on bone turnover Magnesium Mg deficiency as associated with osteoporosis plays a role in a couple of ways. One, the enzyme responsible for converting inactive Vitamin D into it s active form is dependant upon Mg. Two, Mg plays a role in the mediation of certain hormones that regulate blood calcium levels. MAGNESIUM HEALTHY RANGE MG/DL CLINICAL RANGE MG/DL CRITICAL RANGE: <1.0 MG/DL AND > 5.0 MG/DL. BEST FOOD SOURCES GREEN LEAFY VEGETABLES, NUTS, SEEDS Magnesium (Mg) Elderly Need Extra Mg Between 60-65% of Mg in the human body is found in bone. Mg that does not exist as part of bone, is mainly found within muscle This mineral is involved in over 300 enzymatic reactions Magnesium oxide, one of the most common because it has high magnesium content per weight, has been reported to be the least bioavailable Firoz M, Graber M (December 2001). "Bioavailability of US commercial magnesium preparations". Magnes Res 14 (4): Lindberg JS, Zobitz MM, Poindexter JR, Pak CY (1990). "Magnesium bioavailability from magnesium citrate and magnesium oxide". J Am Coll Nutr 9 (1): Magnesium citrate has been reported as more bioavailable than oxide forms. Walker AF, Marakis G, Christie S, Byng M (2003). "Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study" (free text on-line). Magnes Res 16 (3): Individuals with chronically low blood levels of potassium and calcium may have an underlying problem with magnesium deficiency. Magnesium supplements may help correct the potassium and calcium deficiencies. Shils ME. Magnesium. In Modern Nutrition in Health and Disease, 9th Edition. (edited by Shils, ME, Olson, JA, Shike, M, and Ross, AC.) New York: Lippincott Williams and Wilkins, 1999, p Older adults are at increased risk for magnesium deficiency. The and National Health and Nutrition Examination Surveys suggest that older adults have lower dietary intakes of magnesium than younger adults. Ford ES and Mokdad AH. Dietary magnesium intake in a national sample of U.S. adults. J Nutr. 2003;133: Bialostosky K, Wright JD, Kennedy-Stephenson J, McDowell M, Johnson CL. Dietary intake of macronutrients, micronutrients and other dietary constituents: United States Vital Heath Stat. 11(245) ed: National Center for Health Statistics, 2002:168. Mg absorption and renal excretion of magnesium in older adults. Seniors are also more likely to be taking drugs that interact with magnesium. This combination of factors places older adults at risk for magnesium deficiency. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. National Academy Press. Washington, DC,

9 Mg Dosage and Side Effects Magnesium Citrate, Glycinate or Taurate Magnesium can cause diarrhea. Use Mg Taurate to Mg induced diarrhea. Nutrient lbs lbs Over 190lbs Magnesium 200mg 300mg 400mg VITAMIN D (25-HYDROXY D) HEALTH RANGE: CLINICAL RANGE: BEST SOURCES SUNLIGHT COD LIVER OIL, 1 TBS. PROVIDES 1,360 IU HERRING, 3 OZ PROVIDES 1383 IU SALMON, COOKED, 3.5 OZ PROVIDES 360 IU MACKEREL, COOKED, 3.5 OZ, 345 IU SARDINES, CANNED IN OIL, DRAINED, 1.75 OZ, 250 IU TUNA, CANNED IN OIL, 3 OZ, 200 IU Vitamin D and Mortality Older people with insufficient levels of vitamin D may be at an risk of dying from heart disease than those with adequate levels of the vitamin 3,400 Americans followed for 7 years Those with low vitamin D levels were 3x more likely to die from heart disease and 2.5x more likely to die from any cause Current dosage recommendations for vitamin D supplementation appear to be inadequate in most older adults to support these higher [vitamin D] levels that are associated with optimal general health and reduced mortality, wrote the researchers in the Journal of the American Geriatrics Society. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults, Journal of the American Geriatrics Society, September 2009, Volume 57, Issue 9, Pages: Vit D may MetS risk 3,262 Chinese people aged between 50 and 70 94% were vitamin D deficient or insufficient 42% of these people also had metabolic syndrome. People with the lowest average 25(OH)D levels (28.7 nmol/l) were 52% more likely to have MetS than people with the highest average 25(OH)D levels (57.7 nmol/l). Vitamin D deficiency is becoming a condition that is causing a large burden of disease across the globe with particular deleterious impact among the elderly, said researcher Dr Oscar Franco from Warwick Medical School in England. Ed Yong from British charity Cancer Research UK said: "The amount of sunlight it takes to make enough vitamin D is always less than the amounts that cause reddening or burning, so it should be possible to get the benefits of this vitamin without increasing the risk of skin cancer. Plasma 25-hydroxyvitamin D Concentration and Metabolic Syndrome among Middle-aged and Elderly Chinese. Diabetes Care 2009 Published online ahead of print, doi: /dc Vitamin D Levels May Cardiovascular Disease & Diabetes High levels of vitamin D 33% risk of developing cardiovascular disease 55% risk type 2 diabetes 51% metabolic syndrome High levels of vitamin D among middle-age and elderly populations are associated with a substantial decrease in cardiovascular disease, type 2 diabetes and metabolic syndrome, the researchers posit that: If the relationship proves to be causal, interventions targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders. Johanna Parker, Omar Hashmi, David Dutton, Angelique Mavrodaris, Saverio Stranges, Ngianga-Bakwin Kandala, Aileen Clarke, Oscar H. Franco. Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas, Volume 65, Issue 3, March 2010, Pages How much? Gotta test! 25-Hydroxy Vitamin D IU/DAY Cholecalciferol (D3) Avoid ergocalciferol (D2) 9

10 Potassium Decreased in: POTASSIUM HEALTHY RANGE: MMOL/L CLINICAL RANGE: MMOL/L CRITICAL RANGE: <2.5 MEQ/L AND >6.5 MEQ/L. BEST FOOD SOURCES AVOCADO, SWEET POTATO, BANANA, BROCCOLI, COCONUT WATER Hypertension 80-90% will have low K Primary aldosteronism seen with headaches, nocturia (waking at night to urinate), polyuria (frequent urination), fatigue, hypertension, potassium depletion and this may be associated with possible small benign adrenocortical adenomas. Cushing s syndrome from excess secretion of the adrenal cortex or the most common cause is from steroid drug use. Symptoms include moon face, obesity, hypertension, diabetes, and osteoporosis. Low intake of K Vomiting Diarrhea (check for blood in stool) Fistulas (check for blood in stool) Laxatives (check for blood in stool) Diuretics Burns Excessive perspiration Malnutrition Colorectal tumor (check for blood in stool) Alcoholism Folic acid deficiency Kidney disease (do urine analysis) Anemia Hypertension Diabetes Hyperinsulinism Celiac sprue (check for food allergies and gluten sensitivities) Weak heart cells Drugs: Diuretics: Furosemide, Thiazides, Ethacrynic acid etc. Corticosteroids IV EDTA Laxatives Aldosterone Licorice Bicarbonates (alkalosis) Insulin therapy Potassium In rare cases, habitual consumption of large amounts of black licorice has resulted in hypokalemia. Licorice contains a compound (i.e., glycyrrhizic acid) with similar physiologic effects to those of aldosterone, a hormone that increases urinary excretion of potassium. Because potassium is so strictly regulated by the body, low dietary intakes of potassium do not generally result in hypokalemia. However, research indicates that insufficient dietary potassium increases the risk of a number of chronic diseases. Low Potassium Intake and Stroke 43,000 men followed for eight years Men with median intake, 4,300 mg/day were only 62% as likely to have a stroke than those with median intake of, 2,400 mg/day Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98(12): Those with potassium intakes higher than 1,352 mg/day were only 72% as likely to have a stroke as those with potassium intakes lower than 1,352 mg/day Bazzano LA, He J, Ogden LG, et al. Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study. Stroke. 2001;32(7): A prospective study in 5,600 men and women older than 65 years found that low potassium intake was associated with a significantly increased incidence of stroke in individuals not taking diuretics Green DM, Ropper AH, Kronmal RA, Psaty BM, Burke GL. Serum potassium level and dietary potassium intake as risk factors for stroke. Neurology. 2002;59(3): Potassium Intake and Osteoporosis Multiple cross-sectional studies have reported significant positive associations between dietary potassium intake (fruits and veggies) and BMD in populations of premenopausal, perimenopausal, and postmenopausal women as well as elderly men New SA, Bolton-Smith C, Grubb DA, Reid DM. Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr. 1997;65(6): New SA, Robins SP, Campbell MK, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr. 2000;71(1): Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4): How it works Potassium-rich foods, such as fruits and vegetables, are rich in precursors to bicarbonate ions, which buffer acids in the body. When the quantity of bicarbonate ions is insufficient to maintain normal ph, the body is capable of mobilizing alkaline calcium salts from bone in order to neutralize acids consumed in the diet and generated by metabolism. Increased consumption of fruits and vegetables reduces the net acid content of the diet and may preserve calcium in bones, which might otherwise be mobilized to maintain normal ph. Morris RC, Frassetto LA, Schmidlin O, Forman A, Sebastian A. Expression of osteoporosis as determined by diet-disordered electrolyte and acid-base metabolism. In: Burkhardt P, Dawson- Hughes B, Heaney R, eds. Nutritional Aspects of Osteoporosis. San Diego: Academic Press; 2001:

11 Coconut Water Potassium supplementation Never without a blood test! The use of more potent potassium supplements in potassium deficiency requires close monitoring of serum potassium concentrations. You cannot overdose on potassium rich foods. Nutrient lbs lbs Over 190lbs Potassium 50mg 90mg 150mg Low Cholesterol CHOLESTEROL HEALTHY RANGE MG/DL CLINICAL RANGE MG/DL CRITICAL: <110, >300 LOW CHOLESTEROL IS AN OMINOUS SIGN. DECREASED in: Malnutrition Malabsorption Hyperthyroidism Myeloma Polycythemia Cancers Leukemia Severe liver disease Thalassemia Chronic anemia Infection Inflammation Drugs: Cortisone ACTH Statins Nutrients to consider EPA/DHA mg GLA 240mg/day Dietary fatty acids Fish Coconut oil/butter Nuts and seeds Avocado check liver function Cholesterol, Mortality Several studies have indicated that low, rather than high total and LDL cholesterol levels have been associated with increased mortality in the elderly Arnold AM, Psaty BM, Kuller LH, et al. Incidence of cardiovascular disease in older Americans: the cardiovascular health study. J Am Geriatr Soc 2005; 53: Krumholz HM, Seeman TE, Merrill SS, et al. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 1994; 272: Reuben DB, Ix JH, Greendale GA, Seeman TE. The predictive value of combined hypoalbuminemia and hypocholesterolemia in high functioning communitydwelling older persons: MacArthur Studies of Successful Aging. J Am Geriatr Soc 1999; 47: Schatz IJ, Masaki K, Yano K, et al. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet 2001; 358: Tikhonoff V, Casiglia E, Mazza A, et al. Low-density lipoprotein cholesterol and mortality in older people. J Am Geriatr Soc 2005; 53: LDL protective against Salmonella infection in mice Mice were injected with Salmonella. Follow up 21 days LDLR-/- mice Only 5% died within 12 days of infection had a 100- to 1000-fold lower bacterial burden in their organs LDLR+/+ 100% of the mice died within 12 days of infection No differences were found in production of cytokines, phagocytosis, or killing of Salmonella organisms. Netea MG, Joosten LAB, Keuter M, Wagener F, Stalenhoef AFH, et al. (2009) Circulating Lipoproteins Are a Crucial Component of Host Defense against Invasive Salmonella typhimurium Infection. PLoS ONE 4(1): e4237. doi: /journal.pone

12 Why? Lipoproteins protect against infection by interfering with the binding of Salmonella to host cells, thus preventing organ invasion. This leads to an altered distribution of the microorganisms during the first hours of infection: after intravenous injection of Salmonella into LDLR+/+ mice, the bacteria invaded the liver and spleen within 30 minutes of infection. In contrast, in LDLR / mice, Salmonella remained constrained to the circulation from where they were efficiently cleared, with decreased organ invasion. Netea et al conclude: Lipoproteins protect against infection by interfering with the binding of Salmonella to host cells, and preventing organ invasion. Netea MG, Joosten LAB, Keuter M, Wagener F, StalenhoefAFH, et al. (2009) Circulating Lipoproteins Are a Crucial Component of Host Defense against Invasive Salmonella typhimurium Infection. PLoS ONE 4(1): e4237. doi: /journal.pone TRIGLYCERIDES Healthy range mg.dl Clinical range mg/dL 95% of tissue storage fat is triglycerides. Low triglycerides DECREASED in Proteinemia Malnutrition Recent weight loss Vigorous exercise Cancer Depression/Anxiety Drugs: Vitamin C Alpha1 receptor blockers Phenformin Progestins Metformin Aminosalicylic acid Nutrients to consider: increase total caloric intake Summary General Malnutrition Total Protein Albumin Globulin BUN Creatinine Creatine Kinase Chloride Fe Cholesterol Triglycerides Alkaline Phosphatase K, Ca, Mg, D Watch out for WBC RBC Thyroid values Liver enzymes (SGOT/AST, SGPT/ALT) In greatly depleted states, you may start to see increased creatine kinase, BUN and creatinine due to increase muscle catabolism Multiple Vitamin & Mineral (MVM) SUPPLEMENT QUALITY MVM may boost mood in elderly 225 hospitalized acutely ill older people average age 75.6 randomly assigned to receive either normal hospital diet plus MVM or normal hospital diet plus placebo for six weeks. folate and vitamin B12 levels significantly in the MVM group but in the placebo group Significant differences were also reported for symptoms of depression scores between the groups, with beneficial effects observed for patients in the supplementation group regardless of the initial level of depression of the individual "Effects of dietary supplements on depressive symptoms in older patients: A randomised double-blind placebo-controlled trial" Clinical Nutrition (Elsevier) Published on-line ahead of print, doi: /j.clnu MVM and Aging 586 women aged between 35 and 74 Telomeres of daily MVM users may be on average 5.1% longer than in nonusers. "Multivitamin use and telomere length in women, American Journal of Clinical Nutrition, June 2009, Volume 89, Number 6, Pages

13 What about one-a-day One-a-day MVMs usually do not provide sufficient amounts of many nutrients such as vitamin E, calcium, magnesium, and vitamin C. Because one-per-day formulas typically do not contain even the minimum recommended amounts of some of the nutrients listed here, multiples requiring several capsules or tablets per day are preferable. Simple biochemistry explains you can only absorb a limited amount of certain vitamins and minerals at one sitting. With three- to six-per-day multiples, intake should be spread out at two or three meals each day, instead of taking them all at one sitting. Quickly Discern Quality Vit D: cholecalciferol not ergocalciferol Vit E: d-alpha not dl-alpha other ingredients Artificial colors? Artificial sweeteners? Hydrogenated fat? Centrum Silver 1 tablet Amt Per Ingredients Units Serving Calories Total 5 Total 2 g Other Carbohydrate Ingredients Sugars <1 g Sorbitol, Vitamin A Dibasic Calcium Phosphate, Microcrystalline (75% as Beta 4000 IU Cellulose, Calcium Carbonate, Ascorbic Acid (Vit C), Carotene) Magnesium Vitamin C 75 Oxide, mg dl-alpha Tocopherol Acetate (Vit E), Vitamin Gelatin, D 400 Natural IU& Artificial Flavors, Contains <2% Vitamin E 70 IU of: Ascorbyl Palmitate, Aspartame, Beta Carotene**, Thiamin (B1) 2.2 mg Biotin, Riboflavin BHT, Calcium Pantothenate, Cholecalciferol (Vit 2.7 mg D), (B2) Chromic Chloride, Citric Acid, Crospovidone, Niacin (B3) 12 mg Cupric Oxide, Cyanocobalamin (Vit B12), FD&C Red Vitamin B6 7 mg 40 Folate,Folic Aluminum Lake, Folic Acid, Lactose, Lutein, 500 mcg Magnesium Acid,Folacin Stearate, Manganese Sulfate, Mono and Vitamin B12 25 mcg Diglycerides, Niacinamide, Nickelous Sulfate, Biotin 45 mcg Partially Pantothenic Hydrogenated Soybean Oil, Potassium 10 mg Iodide, acid Pyridoxine Hydrochloride (Vit B6), Riboflavin Calcium 200 mg (Vit B2), Silicon Dioxide, Sodium Ascorbate, Sodium Iodine 100 mcg Benzoate, Magnesium Sodium 50 mg Citrate, Sodium Metasilicate, Sodium Zinc Metavanadate, 15 mg Sodium Molybdate, Sodium Selenium 22.5 mcg Selenate, Sorbic Acid, Stannous Chloride, Starch, Copper 2 mg Stearic Manganese Acid, 50 Sucrose, mg Thiamine Mononitrate (Vit B1), dl-alpha Chromium Tocopherol, 100 mcg Vitamin A Acetate (Vit A), Zinc Molybdenum 25 mcg Oxide, May Also Contain: Sodium Aluminum Silicate, Nickel 5 mcg Contains Tin Sulfur 10 Dioxide. mcg Silicon 4 mg Vanadium 10 mcg Lutein 250 mcg COQ10 FOR AGING Food sources: fish, meat, b-vitamin sources 13

14 Coenzyme Q10 (Ubiquinone) Ubiquinol for Aging Potent antioxidant that protects cells against toxic oxygen products that play a role in aging and age-related diseases Generates energy in the form of ATP. Organs with the highest energy requirements such as the heart and the liver have the highest CoQ10 concentrations. During aging CoQ10 levels decrease and oxidative damage accumulates. Heart, skeletal muscles and brain, that are rich in mitochondria, are most affected. Patients with age related conditions, heart disease, degenerative muscle disease and some neurodegenerative diseases show low levels of CoQ10 supplementation retards mitochondrial decline in aging animal skeletal muscle benefits patients with congestive heart failure, heart attacks and those on cholesterol lowering medications (statins). Ubiquinol is the biologically reduced form of ubiquinone (CoQ10) 100mg Ubiquinol ~ 300mg Ubiquinone (CoQ10) Ubiquinone (CoQ10) can be converted by the body into ubiquinol. While supplemental ubiquinone (CoQ10) plays a valuable role in health and can be utilized by the body, recent studies indicate that as people age, the body's ability to convert ubiquinone to ubiquinol begins to decline. In one study, older adults with suboptimal cardiovascular function were found to be able to support and maintain their cardiovascular function with supplementation of ubiquinol. What causes deficiency? Ubiquinol References If CoQ10 is synthesized in our bodies, how can deficiency occur?. #1 Insufficient diet: Biosynthesis of CoQ10 is a complex 17-step process involving Vitamin C and many B vitamins including pantothenic acid. #2 Impairment of CoQ10 biosynthesis. For example, CoQ10 is formed through the same pathway as cholesterol. As a result, the use of statin drugs (cholesterol lowering drugs) severely depletes CoQ10 levels in the body. The catch-22 is, in treating heart disease we use drugs that deplete natural compounds that in turn are necessary to fight heart disease. Drugs such as blood pressure medications, anti-diabetic drugs, certain antidepressants, and birth control pills also inhibit CoQ10 formation. #3 Excessive use of CoQ10 by the body. This again can be related to medications, aging or other causes such as excessive physical exertion, hypermetabolism (hyperthyroidism), and acute shock states. In addition, certain dietary habits increase your need for CoQ10 or supplementation of the nutrients used in the metabolism of CoQ10. For example, coffee and sugar consumption rapidly depletes B-vitamins. These are all instances where the body s requirement for CoQ10 is increased. Frei B, Kim MC, Ames BN. Ubiquinol-10 is an effective lipid soluble antioxidant at physiological concentrations. Proc Natl Acad Sci U S A June; 87(12): Hosoe K, Kitano M, Kishida H, Kubo H, Fujii K, Kitahara M. Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol Feb;47(1): Langsjoen PH, Langsjoen AM. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4): Maroz A, Anderson RF, Smith RA, Murphy MP. Reactivity of ubiquinone and ubiquinol with superoxide and the hydroperoxyl radical: implications for in vivo antioxidant activity Free Radic Biol Med Jan 1;46(1): Yan J, Fujii K, Yao J, Kishida H, Hosoe K, Sawashita J, Takeda T, Mori M, Higuchi K. Reduced coenzyme Q10 supplementation decelerates senescence in SAMP1 mice. Exp Gerontol Feb;41(2): VITAMIN E IS A TERM FOR A PRODUCT OF 8 VITAMERS ALPHA- TOCOPHEROL BETA- TOCOPHEROL DELTA- TOCOPHEROL GAMMA- TOCOPHEROL 4 TOCOTRIENOLS GAMMA-TOCOPHEROL IS THE MOST COMMON DIETARY FORM OF VITAMIN E AND IS A CRITICALLY IMPORTANT FORM OF VITAMIN E IN TERMS OF ANTIOXIDANT BENEFIT. TAKING ALPHA-TOCOPHEROL BY ITSELF DECREASES GAMMA-TOCOPHEROL LEVELS. Understanding Vitamin E Vitamin E Vegetable oils. Corn, sunflower, sesame, cottonseed, peanut, rice bran, and palm oils. Nuts - almonds, walnuts, peanuts, pistachios and hazelnuts. Legumes and grains, corn, lentils, wheat, rice, northern beans, chickpeas, barley grass and oats. Wheat germ oil, Wheat germ oil has been used since the '20s as a vitamin E supplement. It offers a good combination of tocopherols plus tocotrienols. 14

15 Vitamin E Tocotrienols Protects the body from various toxins such as mercury, lead, ozone, and nitrous oxide. Supports a healthy circulatory system and assists in maintaining normal cholesterol levels. Assists in maintaining healthy immune system function. Powerful antioxidant Reduces the negative effects of ionizing radiation Tocotrienols show promising nonantioxidant activities in various in vitro and in vivo models. In certain systems, there is evidence that tocotrienols may even possess greater antioxidant activity compared with tocopherols. Lowering of cholesterol levels Prevention of cell adhesion to endothelial cells Suppression of tumor cell growth Suppression of glutamate-induced neurotoxicity Tocotrienols: Constitutional Effects in Aging and Disease, The American Society for Nutritional Sciences J. Nutr. 135: , February 2005 Vitamin E Vitamin E is a fat soluble vitamin! Guess What?! Mixed tocopherols d-alpha tocopherol 400 I.U. Gamma-tocopherol 280 mg Beta- and Delta-tocopherol 40 mg Mixed tocotrienols 50mg VITAMIN C Citrus fruits, tomatoes, red pepper, parsley, guava, kiwi, papaya, brussel sprouts, kale Vitamin C and Longevity 4 year study of 8,860 men and 10,636 women 20 mm/l rise in plasma ascorbic acid level can reduce all-cause mortality rate by 20% independent of age and other risk factors. A 20 micromol/l increase can be obtained by increasing fruit and vegetable intake by 50 grams per day (~2oz). Higher vitamin-c levels were associated with lower systolic blood pressure and body mass index (BMI) as well as with a higher level of "good" (HDL) cholesterol. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. The Lancet, Vol. 357, March 3, 2001 This is probably equivalent to 2,000-4,000mg/day depending on size Vitamin C Heart Disease & Cataracts Many researchers believe that vitamin C's ability to protect against heart disease is because of antioxidant protection of cholesterol. It s also believed cataract formation may be delayed or prevented by vitamin C as it prevents the free radical damage caused by UV light upon the lens of the eye. 15

16 Super C Vitamin C has many other benefits: Collagen formation Collagen is necessary for connection of ligaments and tendons, blood vessels and in the lining of the joints. Promotes tissue growth and wound healing Aids absorption of calcium and iron and utilization of folic acid. individuals with a genetic predisposition towards iron overload should be careful with respect to vitamin C consumption. Helps detoxify alcohol and cancer causing nitrites, which are preservatives found in lunchmeats and hot dogs. Help weaken viruses and bacteria, which may make symptoms of an upper respiratory illness less severe and resolve sooner. Lessen histamine levels in the bloodstream Offers some protection against many cancers, including mouth, throat, esophagus, stomach, colon, breast and lung. Vitamin C is quite safe even in relatively high doses. Vitamin C Side Effects & Concerns The main side effect of high doses of vitamin C is diarrhea This side effect can be minimized by gradually increasing the dose over a period of time, and dividing the dose throughout the day. Dosage: The RDA for vitamin C is 60 mg This is the amount necessary to prevent deficiency syndrome known as scurvy Doses up to 5000 mg a day for more than three years have been shown to be safe and without side effects. Vitamin C: Prolonging Life? Antioxidants A study over a year period showed that males with the highest blood serum levels of vitamin C experienced a 57% drop in their risk of dying from any cause compared to males with low circulating levels of vitamin C. Among men and women ages years, just a 50mg increase in vitamin C consumption was able to reduce the relative all-cause mortality rate by 20% Loria CM, et al, Vitamin C status and mortality in US adults, American Journal Clinical Nutrition 72: , Another study published in 2001 also confirms a 25-29% decreased all-cause mortality rate among adults with normal to high circulating levels of vitamin C. Researchers have demonstrated that vitamin C slows down telomere shortening by 52-62% in a controlled experiment. Furumoto K, et al, Age-dependent telomere shortening is slowed down by enrichment of intracellular vitamin C via suppression of oxidative stress, Life Sciences 63: , Vitamin C minimum mg/day Vitamin E minimum IU/day d-alpha tocopherol (not dl-alpha tocopherol) OR mixed tocopherols and tocotrienols B-Complex (50mg/day) Why? Medications deplete many b-vitamins Liver support Those with higher B-12 levels 6X less likely to experience brain shrinkage Neurology, Sep 2008; 71: The body uses certain b-vitamins to make CoQ10. naturally occurring substance required by all the cells of the body with particularly high concentrations in the heart and liver. Vitamin B1 (thiamine) whole-grain cereals, bread, red meat, egg yolks, green leafy vegetables, legumes, sweet corn, brown rice, berries, and yeast. Vitamin B2 (riboflavin) whole-grain products, milk, meat, eggs, cheese and peas Vitamin B3 (niacin) meats, fish, brewer's yeast, milk, eggs, legumes, potatoes and peanuts. Vitamin B5 (pantothenic acid) meats, legumes and whole-grain cereals. Vitamin B6 (pyridoxine) liver, meat, brown rice, fish, butter, wheat germ, whole grain cereals, and soybeans. Vitamin B7 (biotin) Nuts, liver, egg yolks, soybeans and fish Vitamin B9 (folic acid) yeast, liver, green vegetables, and whole grain cereals Vitamin B12 (various cobalamins) liver, meat, egg yolk, poultry and milk. Chloride for Digestion Betaine HCl 496mg Betaine HCl 146mg Pepsin Recommend Check serum chloride levels If chloride is normal and proteins are low, recommend Betaine HCl Gas/bloating within 1 hour after meal Dosage depends on severity 1 per day to 1 per meal 16

17 Enzymes for Digestion Basic Supplementation Without Testing Serum: low BUN, low minerals (Ca, Mg, P), low SGOT (AST)/SGPT (ALT) Gas/bloating 2 hours after meal Ultrazyme 1-2 per meal Lipase 1,000 USP Units Amylase 12,500 USP Units Protease 12,500 USP Units Bromelain 150 m.c.u. (a proteolytic enzyme from the pineapple plant) Extract of Ox bile 50 mg Cellulase. 3 W.C.A. units L-Lysine Hydrochloride 50 mg Pepsin 1:10, mg Multiple Vitamin and Mineral Vitamin D3 Calcium Magnesium Vitamin C B-Complex B12/Folate (1000mcg/400mcg) CoQ10 in the form of Ubiquinol Supplementation Supplementation Supplementation needs to depend on bloodwork. Good research supports trying this: Good Multiple Life Source (2/day) (iron free) 180 tab $ Blue Bonnet Super Earth Multi Nutrition Formula (3/day) (iron free) 180 pills $ Enzymatic Therapy Doctor s Choice (3/day) (18mg Fe in 3 tabs) (Men or Women s formula) 90 tabs $ **Douglas Labs Added Protection III (6/day) (can get w/ or w/o iron) 180 tab $20.06 Ultra Preventive X (8/day) (no iron) 240 tabs $40.59 CoQ10: mg/day Jarrow QH-Absorb 200mg (Ubiquinol) 30 gels $49.95 **Ubiquinol QH 100mg/capsule 60 lozenges $64.15 Vitamin E: 400IU/day Carlson s Elite E-Gems 120 gels Health Foods Unlimited Brand Perfect E 60 gels **Nutri E Complex 100 gels Vitamin C: 2-4grams/day Carlson s TR Mild C 1000mg/tab 100 tab $15.90 Health Foods Unlimited brand 1000mg/tab 250 tab $30.99 **C-Ribose 4000mg/tsp 200gm bottle $42.88 **Douglas Labs Natural C 1000mg/pill 250 tabs $19.24 Supplementation Supplementation Vitamin D3 (Cholecalciferol): sunlight and/or IU/day Carlson s drops 2000IU/drop $19.98 Health Foods Unlimited brand 5000IU/tab 60 tab $11.69 **Back To Health 5000IU/pearl 250 pearls $16.04 Calcium (MCHC, Lactate or Citrate): mg/day Source Naturals 1000mg/3 tabs 90 tabs $9.50 Health Foods Unlimited brand Calcium Citrate w/ Vit D 430mg/2tab 120 tabs $12.49 **Standard Process Calcium Lactate powder 800mg Ca, 160mg Mg per 1 tablespoon 340gms $29.00 (about 34 svgs per container) **Douglas Labs Calcium MCHC 250mg/pill 250 tabs $24.35 Magnesium: mg/day Source Naturals Magnesium Malate 425mg/3 tabs 90 tabs $9.50 Nature s Life Magnesium Malate 200mg/pill 100 tabs $10.39 **Douglas Labs Mag-Malate 100mg/pill 90 tabs $12.71 **Douglas Labs Magnesium Taurate 400mg/4 tabs 120 tabs $11.81 B-Complex: 50mg/day Carlson s B-Complex tabs $14.50 Health Foods Unlimited B-Complex tabs $24.49 **B-Complex 90 tabs $

18 Experience and Observations Thoughts On Longevity The longest living are not super athletes They are not obese They are easy going and handle stress and life situations gracefully. I believe the fact that we are living longer is going to change. #1. In America, people are living longer than ever. America is only 28th in the world in regards to longevity. We have more hospitals, more medical doctors, and we take 1/3 of all drugs produced in the world. There are 18 countries that have an average life span longer than we do in the US. #2. Forty years ago, your odds of getting cancer were 1 in 20. In 1990, your odds of getting cancer were 1 out of 3. The fastest growing diseases in children are asthma and diabetes. Longevity The people living longer today were born in the early 1900 s. Were not exposed to all the drugs, antibiotics, vaccines, fast food and other factors that we are today. I believe that as this older generation dies off, we are going to start to see decline in longevity. I believe that it is inevitable. I know that the medical doctors are anticipating life spans of even longer than that with their medical advances of drugs, genetic engineering, etc. I don t believe that is going to be the way to live longer. Longevity American Public Health Association Report The average American life span fell to 69.3 years, a number surpassed by 28 nations including Japan, United Kingdom, Germany and France yrs was the average about 10 years ago in the US This nation's infant mortality rate is more than double that of Japan. Obesity rates in America have virtually doubled over the past 15 years. Diabetes is the fastest growing disease in every age group #1 Cause of Death: Cancer #2: Heart disease, Stroke, etc. #3: Iatrogenic Deaths Longevity continued It is up to you I do believe people have the possibility of living to be 120 years of age and older, if they are willing to make some healthy lifestyle changes. The only way to know if you are on the right track to living to be 120 or older is to test and test regularly. Good Health doesn t just happen It isn t what you know that counts It is not what you intend to do With consistent discipline you can be healthier. 18

19 SCIENCE BASED NUTRITION PHILOSOPHY PROVIDES A SYSTEM OF ANALYSIS... Not a Cure For Disease. Lectures focus on advanced laboratory analysis with nutritional protocols NUTRITIONAL NEEDS FOR THE ELDERLY SESSION 1 & 2 NOTES