The Basic Metabolic Panel…Your Blood Lab Tests.

Most people typically go yearly to have a physical and also have routine blood labs drawn.  One of those routine test usually include “The basic metabolic panel (BMP), which tests for a variety of indicators of metabolic functioning, which includes glucose (blood sugar), electrolyte and fluid balance, and kidney function & operation.  Glucose, calcium, sodium, potassium, carbon dioxide, chloride, urea nitrogen, creatinine, and the glomerular filtration rate (GFR) are also included in the BMP, which is used to detect and diagnose issues like diabetes and kidney disease or malfunction.

If you are on regular medications, your Doctor may also run this panel to make sure the medication is working properly or if it’s tossing other lab values out of balance.  Example would be, diuretics used to treat someone with high blood pressure may end up throwing off the electrolyte balance and the kidneys, so a BMP is usually recommended for someone taking these prescriptions.

One of the issues with BMP tests is that “trending” lab values – numbers that are considered to fall within the normal range but are headed in the wrong directions – are rarely discussed with the patients.  In other words, “low normal” and “high normal” lab values are not typically treated as a concern.  Instead, the usual approach would be to “watch” and “wait” for a trending lab to walk into the “abnormal” zone.  By this time, a disease or other medical issue has usually had time to develop.

A Kaiser Permanente Study that tracked over 46,000 folks for more than a decade, demonstrated the limitations of using this approach.  According to the study, for every one-point rise in fasting blood sugar over 84 mg/dL, a persons risk of diabetes increases by approximately 6 percent!  This may seem like a minor “slight” increase, however, by the time blood glucose levels reach 90-94 mg/dL, the risk of developing actual diabetes has now increased by 49 percent!  If the blood glucose levels reach the highest normal range of 95-99 mg/dL, the risk is more than doubled for becoming diabetic.

When I discuss this with my patient’s many are shocked because the “normal” range for fasting blood glucose levels is 65-99 mg/dL, which means that their lab values which may actually warrant further considerations are treated as just fine.  More alarming is the fact that when fasting blood sugar reaches a level of 90 mg/dL – a value technically within the normal range – vascular and kidney damage can begin to jump on the scene.  For the most part, doctors do not inform patients about concerns regarding their blood glucose until their level reaches 100 mg/dL, when according to the Kaiser Study – their diabetes risk has already climbed to a staggering 84 percent!  These statistics are a testament to the critical importance of blood tests and why you should understand more about what your lab work is  indicating.  Monitoring and managing trends is just as important as treating abnormal blood values.  In the case of BMP tests, reversing a trend with diet, lifestyle changes and even supplements can help prevent the development of diabetes as well as kidney disease and other medical conditions.

_____________________________________________________________________________________________

LETS TALK MORE ABOUT GLUCOSE

Glucose is a type of sugar that acts as your body’s chief source of energy.  During digestion, the foods rich in carbohydrates which  are (starches and sugars) are broken down into 3 simple sugars ” fructose, galactose, and glucose”.  Once they enter the bloodstream, glucose is transported to each of your cells.  In response to the rise in glucose in your body, the pancreas then releases insulin, which is a hormone that attaches to the cell membrane to allow glucose to be taken out of the blood and then carried to the cells, where it is supposed to be used for energy production, (ATP).

However, excessive carbohydrate and sugar intake in ones diet can disrupt normal glucose metabolism, which trigger blood sugar imbalances.  Excessive insulin release and insulin resistance can cause poor  blood sugar control, leading to chronic high blood sugar, or what is referred to as hyperglycemia.

 

Hypoglycemia occurs because too much insulin is release, which may be due to defective insulin receptors or a deficiency of one or more of the trace minerals needed for blood glucose regulation which would include B vitamins, chromium, magnesium vanadium, as zinc.  Low vitamin D can also be a cause, since the vitamin plays a role in insulin production and sensitivity.  when there is a disproportionate amount of insulin in the blood,  this causes glucose to be carried out of the bloodstream and into the cells, which results in a drop in blood sugar.  What happens next is usually symptoms of feeling anxious, agitated, some experience feeling dizzy, some people break out in a sweat or feel overall weak.

 

Besides nutritional deficiencies and defective insulin receptors, blood sugar imbalance can also be related to environmental toxins,  low thyroid hormones, low sex hormones, as well as being subjected to chronic stress.  Both high and low blood glucose are associated with diabetes, heart disease, kidney failure, and other medical issues.  Poorly controlled blood sugar is directly linked to Alzheimer’s disease, Parkinson’s’ disease and autoimmune issues.

Typically if a routine lab test indicates that your blood glucose level is abnormal, then your doctor will more than likely order a fasting blood sugar test, which requires you to abstain from food and drink other that water for about 8 hours.  This test, which is typically used to check for diabetes, can provide a better picture of your glucose level, since it is unaffected by food and drink.  A hemoglobin A1c test, which reflects average blood sugar over the past two or three months may also be recommended.  Specifically, the test will measure the amount of damage done to red blood cells (RBC’s), which occurs when glucose molecules become attached to hemoglobin which is a protein found in RBC.  Other options are the two-hour postprandial (after eating) blood sugar test and the oral glucose tolerance test, which is usually ordered for pregnant women that they suspect may have gestational (pregnancy-induced) diabetes.

_____________________________________________________________________________________

REFERENCE RANGES FOR BLOOD GLUCOSE

Fasting Blood Glucose (mg/dL)                                     Category

Higher than 125                                                              Diabetes

100-125                                                                             Pre-diabetes (impaired fasting glucose)

65-99                                                                                 Normal

lower than 65                                                                  Low (hypoglycemic)

TARGET RANGE: 70-84 mg/dL

_____________________________________________________________________________________________

If you have one or more risk factors it’s actually important that you get in a routine of monitoring your insulin levels.  If you have one or more risk factors for type 2 diabetes like insulin resistance, this is a condition where the hormone insulin does not bind to cells and activate the insulin receptors, so blood sugar is now lowered by producing insulin.  I can say that in most cases insulin resistance more times than not preceded type 2 diabetes and last for at least a decade before being diagnosed as diabetic.  This is a destructive process that connects to a host of medical issues, like Alzheimer’s, breast cancer, hypertension, kidney disease and being over-weight.  Insulin resistance is a defining characteristic of metabolic syndrome, which increases the risk of heart disease, stroke, and non-alcoholic fatty liver disease, ( yes you can get fatty liver disease even if you do not drink alcohol on a regular basis).

One way you can monitor for this is a 2 hr. postprandial blood test, in which glucose and insulin levels are measured 2 hours after eating a meal which contains 75 grams of carbohydrates, like a bagel with jelly.  The results of this test indicate the efficiency with which the body processes glucose and secretes insulin.  Reference ranges for insulin levels are below:

______________________________________________________________________________________

REFERENCE RANGES FOR INSULIN

Insulin (mg/dL)                                                        Category

50 or above                                                                High alert

25-49                                                                            High, trending towards insulin resistance

17-25                                                                            Acceptable

TARGET RANGE: 5-17 mg/dL, with blood glucose less than 90 mg.dL

_________________________________________________________________________________________________

The target range indicates the relationship between insulin and blood glucose levels, this is significant because if both blood glucose and insulin are high, you are at the peak of insulin resistance!  If blood glucose is high and insulin is very low (2 mg/dL, for example), your body is likely in the process of developing diabetes, even if your fasting blood glucose level is considered normal.  If your blood glucose level is somewhere between low and normal and your insulin level is high, you are in the process of becoming insulin resistant.

High insulin can be caused by different factors, like having a diet high in refined sugars and carbs, lack of exercise, being over-weight and genetics play a part too.  Fructose and galactose intolerance, which are hereditary issues, can also be at the root of high insulin, as can antibiotics, corticosteroids, and oral contraceptives and other medications that contribute.  If left untreated, type 2 diabetes is usually the end result.  Low insulin levels are also problematic and can be a signal of type 1 diabetes, hypo-pituitarism (having a underactive pituitary gland) or diseases of the pancreas.  An insulin level of 2 mg/dL or lower in combo with a very high blood glucose reading requires extensive testing.

While insulin is not included on the basic metabolic panel, testing for insulin resistance is crucial.   I am trying to focus on the causes, medical concerns, and recommended treatments for abnormal blood glucose levels, which will allow you to take appropriate action based on the outcome of YOUR lab test.

________________________________________________________________________________________

WHAT CAN CONTRIBUTE OR CAUSE HIGH BLOOD GLUCOSE?

When your body does not produce enough insulin OR cannot use insulin properly, the result ends up being high blood sugar.  This is a symptom of PRE-diabetes, which increases the risk of heart disease and other health issues, even though diabetes has not fully developed.  Some causes of high blood glucose include:

• liver and pancreatic cancer
• chronic stress
• diet high in simple carbs and/or refined sugars
• environment toxins
• hormonal changes or imbalances (estrogen in ladies, testosterone in the gents)
• under active or slow thyroid
• insulin resistance
• kidneys disease
• medications including: birth control pills, corticosteroids, diuretics, epinephrine, estrogen, lithium, tricyclic antidepressants, and salicylates
• nutritional deficiencies in B vitamins, chromium, magnesium, vanadium and/or zinc, which all help regulate blood glucose
• physical trauma, such as injury or heart attack
• weight gain which can lead to insulin resistance

Borderline high blood sugar shouldn’t be ignored, since insulin resistance and type 2 diabetes are likely to happen.  So many of my patients when they are telling me their history say, “oh yeah my doctor said I was borderline diabetic”, like it’s no big deal…Let me restate “IT IS A BIG DEAL” unless you are willing to welcome the added health issue risks of… cancer, dementia, Alzheimer’s, eye disorders, heart disease, high blood pressure, kidney disease, neuropathy (which is nerve damage that is painful), and possibility of stroke!

_______________________________________________________________________________________

CAN YOU TELL YOU BLOOD SUGAR IS HIGH BY HOW YOUR FEEL?

A blood test of course will confirm if your blood sugar levels are too high, but will there also be physical symptoms that may alert you that something isn’t as it should be?  Look for out of the ordinary for YOU:

• fatigue
• increased hunger,
• excessive thirst,
• frequent urination
• slow healing of wounds

Type 2 Diabetes folks typically:

• gain weight around the waist.  Belly fat leads to insulin resistance

Low blood sugar (hypoglycemia):

• anxiety
•  blurred vision
• confusion
• trembling or shaking
• emotional changes, irritable, weepy (typically in children)

Diabetics can also develop hypoglycemia in response to some types of stress and in severe circumstances, very high blood sugar can lead to ketoacidosis, or in some cases diabetic coma.  Some warning signs of this state include:

• shortness of breath,
• stomach pain, fruity smelling breath
• vomiting
• _____________________________________________________________________________________

EPIDEMIC: DIABETES

The number of people being diagnosed with diabetes in the United States is hitting staggering numbers, more than 11 million have been diagnosed and another 7 million live with it unknowingly.  (according to the National Diabetes information Clearinghouse)

One of the most common causes of kidney damage and failure is diabetes; dialysis clinics are popping up faster than Wal-marts in response to a growing number of diabetes patients with chronic kidney failure.

 

There ae two types of diabetes type 1 and type 2.  Type 1 diabetes, used to be known as juvenile diabetes, which is caused by a dysfunction of the immune system in which the body attacks the beta cells – which are the insulin producing cells of the pancreas.  When these cells are destroyed, the body can no longer produce insulin.  The disease, most often occurs in children, and can be triggered by a wide range of factors, including viruses, infections, vaccinations, and allergies to cow’s milk.  Until the development of injectable insulin, type 1 diabetes was usually fatal.

Type 2 diabetes is the most common type.  95 percent of people with diabetes in the United States have type 2, which was once known as adult-onset diabetes.  This term is no longer applicable, since the obesity epidemic as caused many kids under the age of eighteen to develop this condition.  The precursor to type 2 diabetes is insulin resistance.  What happens is over time, the excessive release of insulin as the body attempts to manage blood sugar burns out the beta cells, destroying their ability to make insulin and control glucose levels.  Type 2 has fully developed when blood sugar levels can’t be lowered due to poor insulin release or utilization.  People who have type 2 tend to be overweight; in fact, the disease was first believed to be caused by poor diet and lifestyle, yet new research has shown that hormonal changes, chronic stress, environmental pollutants, and nutritional deficiencies especially magnesium  can contribute to the development of type 2 diabetes.

________________________________________________________________________________________

NUTRITIONAL DEFICIENCIES CAUSED BY BLOOD SUGAR LOWERING MEDICATIONS

DRUG                                          

Ace inhibitors ( captopril, enalapril, fosinapril, lisnopril, quinapril, Ramipril, trandoapril)

 NUTRIENT DEPLETION:  

Sodium & zinc

ASSOCIATED SYMPTOMS:

• decreased immunity
• slow wound healing
• smell & taste disturbances
• anorexia,
• depression
• night blindness,
• joint pain
• involuntary eye movements
• changes to skin, nails & hair
• women may experience menstrual irregularities

_________________________________________________________________________________________

DRUG:

Metformin

NUTRIENT DEPLETION:

CoQ10, folic acid and B12

ASSOCIATED SYMPTOMS:

• CoQ10 depletion can lead to blood sugar imbalances
• heart problems
• lowe energy
• muscle weakness
• decreased immunity
• folic acid depletion can result in blood sugar dysregulation
• cervical dysplasia
• increased risk of cancer
• birth defects
• Low B12 leads to anemia
• depression
• fatigue
• cardiovascular risks
• skin tingling and numbness

_________________________________________________________________________________________

DRUG:

sulfonylureas

NUTRIENT DEPLETION:

CoQ10

ASSOCIATED SYMPTOMS:

• blood sugar imbalance
• heart problems
• low energy
• muscle weakness
• decreased immunity

________________________________________________________________________________________

NUTRITIONAL SUPPLEMENTS FOR SUPPORT                

 

GARLIC:  is used to protect the heart & blood vessels and is reported to help decrease oxidative stress markers, including those related to blood sugar regulation.  Garlic also has been reported to decrease the formation of advanced glycation end-products (AGEs), which are implicated in heart disease, kidney issues and cancer.  Garlic is not reported to interfere with blood thinners. and may be helpful in reducing liver enzymes and fatty liver issues.

ALPHA-LIPOIC ACID: may help with blood sugar uptake and use in the body, and helps detoxify the body, protect the kidneys and improve cholesterol levels.

BILBERRY: has been shown to protect against eye problems that may result from blood sugar imbalance.

BITTER MELON: when combined with chromium and glutathione, bitter melon is reported to help lower blood sugar and hemoglobin A1c as well as helping with weight loss.

CINNAMON: studies have shown cinnamon to improve insulin sensitivity and acts like an antioxidant.

FIBER: Guar gum is a great source of soluble fiber. Flax meal, chia seeds, oat bran, psyllium.  Drink with plenty of water

CHROMIUM: is important for blood sugar and insulin regulation.  people who have a diet high in refined carbs like sugar may also be low in chromium.

MAGNESIUM: supports bone building and balance calcium intake.  Magnesium helps to support blood vessel function and insulin resistance, in addition to decreasing LDL cholesterol, total cholesterol and triglycerides.  Also essential for phase-1 liver detoxification.  If you experience loose stools after taking magnesium, cut your dose in half and gradually increase over the course of a few months.

N-ACETYL CYSTEINE (NAC): is an antioxidant reported to help protect against blood vessel damage and clots due to insulin resistance, diabetes and other blood sugar regulation issues.  It helps improve the body’s capacity to decrease the harmful effects of exposed toxins. and has been reported to improve kidney function in studies, and support glutathione production in the kidneys.

OMEGA-3: excessive inflammation is common in folks who are insulin resistant and diabetic, and can lead to other health issues like immune imbalances sleep issues and heart disease.  Fish oil acts as an antioxidant and decreases inflammation in the body, in addition to supporting heart and blood vessel health.

ZINC: is important in helping our immune system and acts as an antioxidant.  it has been reported to help regulate blood sugar.  May also be used by men to treat low testosterone and support prostate health.

____________________________________________________________________________________________

SEEK OUT A PRACTIONER THAT IS TRAINED IN “NUTRITION”

I highly recommend working with someone who understands healthy nutrition to begin to make dietary lifestyle changes.  There is so much information floating around on the internet that many folks really do get confused as to what works and which way they should go.  Many get so overwhelmed that they just do the best they can out of frustration.

Incorporating the use of particular nutritional enzymes to assist a weakened digestive system (which includes the pancreas), to offer assisted digestion is also recommended.  So work with a nutritionist who is familiar with incorporating enzymes into their practice as I do.  They are a critical addition that should  be implemented.

 

Switching out refined sugar for the popular artificial sugars isn’t the answer, sugar-free this and that; actually make it much harder to control your blood sugar levels.  Not to mention they are what is referred to as “excito-neurotoxins), they actually pump up your fat cells and make you fatter.  It’s not about just the calories, it’s about what is your body supposed to “do” with it once it’s in there….

The next topic I will address will be the calcium aspect of your blood tests, and help you understand the reference ranges and what you are looking for and what nutritional changes you can incorporate.  Until then…. thank you for taking the time to follow, and share my posts.

 

Healthfully yours,

Dr. Jodi Barnett N.D.

Harvested Health LLC

http://www.jodibarnett758.com

References:

James B. LaValle, RPh, CCN “Cracking the Metabolic Code”

Dr. Kurt W. Donsback “Lee Foundation of Nutritional Research” & “Super Health”

https://divisionofresearch.kaiserpermanente.org/projects/distance

http://theamericanchiropractor.com/2012/12/24/defining-food-enzyme-nutrition-an-interview-with-howard-loomis-dc/