Sunday, February 23, 2014

Part 2: GNYDA Health and Wellness Conference 2014



     Apparently Diabetic research has come a long way in the past few years and enabled the innovation of novel new pharmaceutical therapies per Dr. Joyce Vergili’s talk on, “Diabetes Medications Update for Healthcare Professionals.”   She went over the different metabolic defects that are associated with diabetes and the therapies that are available.   It so happens that we only had two classes of drugs for diabetes between 1950 and 1994: Sulfonylureas and Insulin.  In just the past few years we have had an influx of new medications being approved by the FDA for treating Type 2 Diabetes.  Metformin remains as first line therapy as long as none of the following contraindications are present: CHF, renal or hepatic impairment.   In addition to insulin resistance and declining beta cell function, she discussed other newly discovered metabolic defects and the types of therapies that have been invented as a result of this new information.  7 of the newest  drugs developed combat what she referred to as the, “Incretin blunting effect.”  The two incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) are secreted from the small intestine when food is ingested.  As diabetes progresses, these hormones are decreased along with insulin.  Incretin is involved in the stimulation of insulin production and inhibition of glucagon secretion.  Moreover, these proteins are degraded by the enzyme dipeptidyl peptidase-4 (DPP-4).   In response the following two classes of drugs have been developed which are depicted in the table below with the medications for each grouping.
Table 1: New Incretin Based Therapies
Class
DPP-4 inhibitors (oral)
GLP-1 Receptor Antagonists (injectable)
Medications
Sitaglipin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
Exenatide (Byetta)
Liraglutide (Victoza)
Enenatide extended release (Bydureon)

The other metabolic effect she discussed that has yielded newer therapies is the increased renal glucose threshold.   The normal renal glucose threshold is around 180 mg/dL but increases to approximately 200-250 mg/dL in type 2 diabetes.  The sodium glucose co-transporter-2 (SGLT2) transports glucose into the kidney for glucose reabsorption into the bloodstream.  When maximum capacity of glucose is reached in the kidney the excess is excreted into the urine.  As such the following SGLT-2 inhibitors were developed: Canaglifoxin (Invokana) and Dapagliflozin (Farxiga).   
     Finally, Toby Amidor MS, RD blogger for the Food Network gave us a rundown on what can help draw readers to your blog and why we should blog.   To sum up what she said, she encouraged a website that included lots of photos, was not too lengthy (between 250 to 600 words max) and with a little dose of fun.   She also emphasized the importance of blogging for the Dietetics professional.  After all, Dietitians are the food experts and we are competing with non food experts dishing out nutritional advice in the blogosphere.  She pointed out statistics that showed that the majority of Americans trust food blogs and their recommendations.  Granted there are many successful food bloggers out there that do not have the education Dietitians have when it comes to food and nutrition, this can be problematic.  This point makes it even more important for Dietitians to start blogging, and doing so in a way that attracts readers attention and combat misinformation on the internet related to health and nutrition.    

Friday, February 7, 2014

Part 1: GNYDA Health and Wellness Conference 2014


      This past Saturday (thankfully devoid of the snowstorms and bitter cold we have been experiencing more often than not lately) the GNYDA Health and Wellness conference was held at the University Settlement located in New York City’s Lower East Side.  In years past, it was held at the Cornell Campus of NY Presbyterian Hospital.  Nonetheless, the conference continued its’ legacy of inviting quality speakers exposing attendees to varied areas of Dietetics, as well as, providing an excellent networking opportunity.   This years’ event included presentations about integrative nutrition, blogging, and an update on diabetes. 

     First up was Dr. Jaime Schehr, ND, RD, CDN, a Naturopathic Doctor (a.k.a ND) and Dietitian who practices Integrative Nutrition in New York and Connecticut.  It should be noted that an ND is recognized as a primary care provider in 15 states (by the way, NY is not included in that list).  She differentiated between MNT, Integrative Medicine and Integrative and Functional MNT in the following ways:

 -Integrative Medicine is the synergistic integration of traditional natural healing and modern medicine to promote health and wellness and not just treat the symptoms.

-MNT is reducing risk of complications from already diagnosed conditions like diabetes and high cholesterol.

-Integrative and Functional MNT is focused on the overall health and wellness of the patient by promoting diet and lifestyle modifications.

A healthy gut is the foundation of good health according to Integrative Nutrition practitioners.  Intestinal permeability, which can be negatively impacted by stress, can lead to immune compromise and “stimulate hypersensitivity responses to food and components of gut flora.”  She discussed a situation where a patient of hers had not experienced symptoms of celiac disease until she underwent a stressful period in her life.  Food sensitivities, more often than not, can be detected via elimination diets.   Using eliminating diets are less costly than having the patient undergo blood testing to determine the offending IgG and IgE food antibodies.  Dr. Schehr also described a  4 step gut restoration program that involved Removing foods/medicines that may be harming the gut, Replacing nutrients, digestive enzymes, etc. that may be lacking, Re-inoculate healthy bacteria with the use of pre and probiotics, and finally the last step is to Regenerate using dietary supplements and/or modifying the diet.  Some diets she briefly mentioned are as follows: the anti-inflammatory diet, anti-candida diet, FODMAP diet, Blood type diet, and alkaline diet.  She encouraged dietitians to learn as much as possible about dietary supplements as we are seen as the experts in this area, regardless of the lack of formal education we get in this area.  She suggested a site called Emerson Ecologics which RD’s can join for free as another resource to learn more about Integrative Nutrition. 

     I have more to say!  So stay tuned for the second part of the GNYDA Health and Wellness Conference 2014!!!!