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Malnutrition of Obesity and Diabetes
Obesity is expected to suppress tobacco use as most economically importable preventable cause of disease and death. Obesity is not simple as genes, environment, and behavior all contribute to its increasing prevalence and must be addressed if any progress is done to combat this condition. Although diabetes and obesity do not always occur concurrently, there is a definite correlation between these conditions.
In the Western world, increased availability of low-cost, nutrient poor, and high- calorie food is the main driving force behind development of obesity. Even though obese individuals consume high calorie diet, they have higher prevalence of micronutrient deficiencies as compared with general population.
Specific micronutrients like Vitamin D, Chromium, Biotin, and Thiamine, as well as Vitamin C play a significant role in pancreatic function (insulin production) and in glucose metabolism. Low level of these micronutrients results in obese individuals developing diabetes.
Vitamin D
In obese population, prevalence of Vitamin D deficiency can be as high as 80-90%. Most everyone knows of importance of Vitamin D in bone health.
However, there is a growing body of evidence indicating benefit of Vitamin D supplementation for glucose metabolism improvement and insulin signaling. Beta cells of pancreas, area where insulin is made, have receptors for Vitamin D. Insulin gene transcription is responsive to Vitamin D supplementation. There is also an inverse relationship between Vitamin D level and prevalence of Diabetes type 2.
When checking for vitamin D deficiency, it is important to distinguish between 1,25-dihydroxivatimin D and serum 25-hydroxyvitamin D.
It is only important to check 1,25-dihydroxivatimin D levels if patients are on dialysis or with end stage kidney disease and concern for abnormal calcium levels are of concern. To establish what is commonly known as vitamin D Deficiency, doctors will order serum 25-hydroxyvitamin D (See Reference 2).
Several scientific trials showed an improvement in insulin sensitivity with vitamin D supplementation in patients with abnormal fasting glucose and with insulin resistance.
Best results were found in a trial of 90 Diabetics type 2 patients who were given 1000 units of Vitamin D daily for 12 weeks and in another trial where 92 Diabetics type 2 received 2000 units of Vitamin D daily for 4 weeks. Improvements included a decrease in HbA1C (a measure of 3-month diabetes control).
Considering high rate of low vitamin D in obese and diabetic population and its potentially significant positive effect of glucose metabolism, doctors should consider regular testing and supplementation of patients in this population.
Chromium
Chromium is an essential trace metal required for insulin signaling cascade. Chromium deficient patients are usually severely malnourished. They exhibit insulin resistance, high blood fat content, high blood sugar levels, as well as painful neuropathy. These symptoms can resolve rapidly with chromium replenishment.
Yeast and meats are primary sources of chromium. Also, use of stainless steel appliances allows for chromium to move into food during the cooking process. Chromium is primarily stored in the liver. People with type 2 diabetes have approximately 30% or more lower blood chromium levels as compared with general population.
Medical studies that noted greatest positive effects with chromium supplementation used chromium picolinate compound due to its high bioavailability. Use of this compound lead to decrease in insulin resistance and improvement in glucose metabolism. Most studies noted an average improvement in HbA1C by almost 1 %. Use of this supplement in diabetic patients continues to be controversial and novel studies are needed to establish proper dosing and frequency of administration to achieve the best outcomes.
Biotin
Biotin is a water-soluble vitamin, It regulates transcription of insulin receptor and improves function of beta insulin producing cells in pancreas. One of its jobs is to facilitate expression of genes. It serves as an important player in synthesis of fatty acids, citric acid energy generation cycle, and amino acid metabolism. Patients with diabetes tend to have lowered biotin and higher fasting plasma glucose. Animal studies showed increased insulin resistance in rodents with biotin deficiency, which was reversed with biotin replacement.
Diabetic patients, in one study, showed improved fasting glucose and insulin levels after being supplemented with 15 mg of biotin for 28 days. Further improvement was show in studies combining biotin and chromium co administration with 4 weeks needed to note a significant difference.
Thiamin is an important micronutrient that is involved in amino acid and glucose metabolism. When deficient, endothelial dysfunction ensues leading to damage to walls of blood vessels and lymphatic vessels. Recommended daily thiamin dose is 1.2 mg for someone on 2000kcal daily diet. It can be found in red meat, eggs, fish, and legumes. It is not present in simple sugars or milled rice. Interestingly, breakdown of these foods requires thiamin which may quickly lead to deficiency. It is unclear how significant the prevalence of deficiency is in diabetic population. Some studies indicate that it is as little as 20% and as great as 80%. Thiamine supplementation, specifically in studies of #benfotiamine (lipid soluble thiamine analog), reduces #oxidative stress and damage of endothelial walls even when blood glucose concentration is high. It also reduces the presence of glycosylated end products.
These glycosylated end products are lipids and proteins that have been exposed to high levels of sugar in the blood stream. Buildup of these compounds results in increased cell aging and worsening of degenerative conditions like #diabetes, #arterial and #kidney disease, and even #Alzheimerāsā disease.
Vitamin Antioxidants
Despite significant claims to benefits and much research in this area, supplementation with #antioxidants vitamin E, C, and A is not currently recommended for diabetic patients.
Of these vitamins, Vitamin C deficiency is more common in obese patients but can be easily replenished by eating fruits and vegetables. One, however, cannot assume that people are consuming enough or any fruits and vegetables on daily bases and laboratory testing should be undertaken if deficiency is suspected.
References:
1. Via M. The malnutrition of obesity: micronutrient deficiencies that promotediabetes. ISRN Endocrinol. 2012;2012:103472. doi: 10.5402/2012/103472. Epub 2012 Mar 15. PubMed PMID: 22462011; PubMed Central PMCID: PMC3313629.
2. https://labtestsonline.org/tests/vitamin-d-tests