25 Facts About Rheumatoid Arthritis (RA) Everyone Should Know

Rheumatoid arthritis is an illness that’s widely misunderstood. I believe this is partly due to the fact that many confuse it with osteoarthritis (OA). This mix-up leads people to believe rheumatoid arthritis is caused by aging.

Rheumatoid arthritis (RA) is in no way “normal” aging and shouldn’t ever occur at any point in a healthy person’s life!

Rheumatoid arthritis is an autoimmune disease – meaning the body’s immune system is attacking itself – in the case of RA the immune system attacks a person’s joints.

Almost 1.5 million Americans have rheumatoid arthritis and it’s on the rise. Unfortunately, modern medicine doesn’t have much to offer for reversal of this terrible condition. However, functional medicine and full body integrative and holistic approaches have resulted in full recoveries and promising outcomes.

I am a perfect example of this. I was diagnosed with Rheumatoid Arthritis (I was also given many other additional diagnoses – another blog on this later) more than a decade ago. When modern medicine had no answers for me other than prescribing toxic immunosuppressive drugs and steroids, I voluntarily chose not to use those. As a practicing Internal medicine doctor who had a special interest in Rheumatology, I knew all too well, the terrible side effects and long term health consequences of these drugs. I was determined to find other answers!

Against conventional wisdom, I decided to be my own guinea pig and looked for other safer but effective alternatives. I researched and studied the fields of nutrition, and Integrative, Holistic, and Functional Medicine. I trained and became board certified in these, using all that I learnt, first on myself. It was trial and error at that point for me but I eventually healed myself from this crippling disease and from all other diagnoses that conventional medicine had given to my wide range of chronic symptoms!

My health completely recovered, and I no longer carry the clinical or lab diagnosis of RA, nor do I suffer from the pain or the disabling fatigue which is characteristic of this disease. In fact, I feel more energetic and vibrant than I did even in my 20s. I now use the same healing modalities and step-wise approach that worked for me, on my patients to help them in their recovery process.

As with everything else in life, we are all individuals with unique and varied characteristics, so no one size of treatment can fit all. Everyone with RA will have different root cause(s). I help my patients and clients find their particular root causes and then use a very personalized treatment approach that is right for their body.

In an effort to clear the confusion and misunderstanding surrounding rheumatoid arthritis, I’ve compiled 25 facts about rheumatoid arthritis that everyone should know. RA is a condition that can strike any person at any age – and it’s best to know these important facts.

1. Rheumatoid arthritis (RA) is very different from osteoarthritis (OA)

RA is an autoimmune disease while osteoarthritis is caused by erosion of the cartilage and bones due to aging, overuse or obesity. Because these conditions are completely different, so are their treatments and it is important not to confuse the two.

2. Rheumatoid arthritis is not ‘normal’ wear and tear of the joints

Rheumatoid arthritis occurs when the body’s immune system attacks its joints. This attack results in painful inflammation of the hands, feet, knees and other joints. RA can also impact other tissues in the body such as the heart, lungs, mouth, and eyes.

3. Rheumatoid arthritis is more prevalent now than ever before

Many articles on RA like to cite the fact that there’s very little evidence RA existed before the 1500’s, however that fact remains uncertain. What we do know, is RA is more prevalent now than ever before and it’s incidence is on the rise. This fact leads many to believe it is a disease caused primarily by environmental factors such as diet and toxins.

4. Children can develop Rheumatoid Arthritis

It’s possible for children to develop RA -known as Juvenile Rheumatoid Arthritis (JRA) – because it’s an autoimmune condition, not caused by aging. In fact, children as young as five years old can develop RA, which is a deeply troubling to witness.

5. Rheumatoid Arthritis is usually worst in the hands and feet

Though RA can impact any joint and many tissues in the body, it’s most common in the hands and feet. RA attacks the synovial lining between the bones of a joint, causing it to become inflamed, and ultimately damaging the tissue. Over time, RA can cause deformity to the affected joint.

6. Women are three times more likely to develop RA

For reasons that are not fully understood, women are three times more likely to develop RA than men. It is thought that hormones may play a role. Also, the prevalence of RA among women is on the rise.

7. Geography influences RA risk

RA is more common in people who live further from the equator, which suggests that adequate sunshine could help reduce RA risk, which leads me to my next point…

8. Vitamin D reduces risk of developing RA

Sufficient vitamin D significantly reduces your risk of developing RA and sunshine is your best source of vitamin D. Vitamin D has been linked to a reduced risk for nearly all autoimmune disease, so it’s a good idea to daily get about 20 minutes of sunshine, before applying sunscreen (without burning of course). If you have the ability to test your vitamin D levels, please do so and take supplemental Vitamin D under supervision. In my practice I use different strengths of Vitamin D based on my patient’s levels.

9. Exercise is usually recommended in RA

Surprising to some, physical therapy has been shown to improve symptoms of RA. Decades ago, doctors believed exercise would put unnecessary stress on joints and recommended against it. This belief is not true and proper exercise with rheumatoid arthritis is now encouraged.

10. Diet is a vital part of treatment of Rheumatoid Arthritis

Anti-inflammatory diets low in gluten, sugar, processed and fried foods are an integral part of the functional medicine approach to RA. I would recommend working with a Functional medicine doctor and getting detailed food, nutritional and gut assessment so your individual causes for RA can be specifically dealt with.

11. Chronic inflammation is a major component of RA

Rheumatoid arthritis goes hand-in-hand with chronic inflammation. This means you can do yourself a world of good by incorporating anti-inflammatory practices in your life through diet, by reducing the burden of toxins in your body, and by targeted supplementation. The fire needs to be quenched!

12. Muscle atrophy is a concern in RA

Due to the lack of appetite that accompanies RA, coupled with the misguided but common belief that exercise will make RA worse, many people in the past suffered from muscle atrophy. These issues led to the nickname “wasting disease” because those with RA were often rail-thin and “wasting away.” A typical complaint is difficulty opening jars. Adding a daily protein drink or two to your nutritional supplementation can most certainly help replenish muscle strength. . My favorite protein powders are ones which also help gentle detox of the liver and the body.

13. Loss of appetite is common in RA

Due to inflammation of the gut, many with RA experience a strong loss of appetite, which contributes to weakness and muscle atrophy. The best way to fight this is through healing the gut and reducing inflammation.

14. A genetic risk factor called a “shared epitope” in RA

A shared epitope (SE) is a genetic variant that increases the likelihood of developing RA when present, in fact some studies suggest that SE is the single most significant genetic risk factor for RA. Though there’s a genetic predisposition for RA, most believe risk is more associated with environmental factors. Remember, genes are loaded guns but environmental exposures hold the trigger!

15. Heart disease is a problem for RA patients

Having RA significantly increases your risk for developing cardiovascular disease and having a heart attack. This is likely due to the characteristic systemic inflammation present in both conditions.

16. Diabetes risk is higher in RA patients

RA increases the risk of many illnesses, including diabetes, though this could also be caused by the conventional RA treatments, which quite often include intermittent or chronic steroid use. Steroids increase the risk for diabetes. Opting for a functional medicine approach to rheumatoid arthritis could reduce this risk.

17. Fibromyalgia risk is higher in RA patients

There is an increased risk for developing fibromyalgia in patients with RA. Suffering from a combination of these two illnesses can lead to chronic pain, severe depression, fatigue, as well as memory and cognitive issues.

18. Lung disease is a common complication in RA patients

Interstitial lung disease, a serious lung disease can be a frequent complication of RA when the disease activity is not properly controlled, in fact after joints, lungs are the second most common organ to be affected by this disease. Serious respiratory conditions, infections and pneumonia can also occur due to conventional treatments which suppress the immune function; or due to lifestyle habits such as smoking. Any symptom of shortness of breath should be properly investigated.

19. Pregnancy can temporarily improve RA symptoms

Pregnancy often improves symptoms of many diseases, including RA. I believe this is because of the elevated anti-inflammatory elements present in the body during pregnancy, such as the DAO enzyme. However, after a person with RA gives birth, they could experience a flare-up and should plan with their doctor accordingly. Postpartum follow up of RA and for that matter any autoimmune condition is crucial.

20. Giving birth reduces risk for developing RA

Though the reason behind this is not fully understood, research has shown that giving birth reduces a woman’s overall risk of developing RA compared with someone who has never given birth.

21. Smoking increases RA risk and worsens symptoms overall

Smoking cigarettes increases a person’s risk for developing RA. Additionally, smoking cigarettes is a serious trigger for a flare of RA and can worsen symptoms overall.

22. It’s unclear whether alcohol is bad or good for RA

Studies have been published suggesting some alcohol is both good and bad for people affected by RA. It’s my recommendation that you consume as little as possible because alcohol makes it difficult for your body to work on ridding itself of toxins in your everyday life that could be contributing to your RA.

23. Pollution increases Rheumatoid Arthritis risk

Pollution is known to cause inflammation in the body, so it’s no surprise that researchers found women who lived within a third of a mile of a major highway had higher prevalence of systemic inflammation and RA.

24. Psychological stress can have a role in RA

Stress is one of the factors that may not only cause and but also exacerbate the progression of chronic inflammatory diseases such as RA. Relapses are common under conditions of emotional stress. Treatments based on mindful awareness and acceptance therapies lead to reductions in daily pain-related sense of doom and disability, fatigue, as well as stress-related anxiety in RA patients. A holistic mind-body approach is paramount along with other Functional medicine treatments for RA.

25. Functional medicine solutions are promising in RA

Steroids and NSAIDs (some of the conventional treatments for RA) are not a good long term treatment plan. Not only do they not offer long term solutions, they are harmful to the gut and the immune system! They work against the very systems that need healing.

Instead try a functional medicine approach to RA treatment with your Functional Medicine doctor, which includes:

Anti-inflammatory diet – Free of gluten, sugar, fried, and processed foods.
Reducing toxin burden – Cleaning up your household products and cosmetics is a good start. Only use ‘clean’ personal care products without hormone dysrupting chemicals.
Healing a leaky gut – You’ll need to repair your gut lining to help your immune system regain strength. I use a special gut support powder, digestive enzymes and probiotics to balance the gastrointestinal tract function.
Check for bacterial and yeast overgrowth – work with your Functional Medicine doctor to diagnose and treat these.
Check for mycotoxins – Your doctor can also test you for mycotoxins which come from mold. Read my article here on mold clean-up..
Heal any infections – Infections with viruses, yeast, parasites and bacteria can mess with your gut health. Among other infectious causes, Epstein-Barr virus is thought to be a trigger of RA.
Supplementation – Omega-3s, probiotics, vitamin D3, bioavailable forms of curcumin are some of the simple ways to fight the chronic inflammation caused by RA.

Rheumatoid arthritis is a debilitating disease but there are better solutions beyond prescriptions. Reach out to your functional medicine doctor if you or someone you love suffers from rheumatoid arthritis.

Please share this article to help dispel common myths surrounding rheumatoid arthritis.

Please also share how you manage your disease and help others learn from your experiences.

Resources:

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024678/

http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119866/

https://www.niams.nih.gov/health_info/Juv_Arthritis/default.asp

https://www.rheumatoidarthritis.org/ra/

https://www.ncbi.nlm.nih.gov/pubmed/14730601

https://www.ncbi.nlm.nih.gov/pubmed/28808949

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766928/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921962/

https://www.ncbi.nlm.nih.gov/pubmed/24736263

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890244/

https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284707/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717131/

https://www.ncbi.nlm.nih.gov/pubmed/24850878

https://www.ncbi.nlm.nih.gov/pubmed/28638686

https://www.ncbi.nlm.nih.gov/pubmed/25365778

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526553/

Dr. Manisha Ghei October 3rd, 2017

Posted In: Blog Post, Functional Medicine, Functional Nutrition, Integrative Medicine, Rheumatoid Arthritis, Uncategorized

Tags: Autoimmune, Autoimmune disease, Autoimmune MD, Autoimmunity, Chronic fatigue syndrome, fibromyalgia, functional medicine, heart health, Inflammation, Joint, nutrition, OA, Osteoarthritis, RA, Rheumatoid Arthritis, supplements, women

Essential Fatty Acids (EFAs) – Essential to Brain Health

I’m often asked what are the few nutrients I think are absolutely imperative and essential for good health especially in this modern world. One of the top nutrients in my list is Omega Essential Fatty Acids. Every patient who comes into my practice gets their Omega 3 levels and the ratio of Omega 3s to other omegas, like 6s, 9s etc tested and an appropriate individualized diet and supplementation (if required) plan created for them.

Decades of study and countless books have gone into exploring Omega-3 and the role it plays in our physical and mental health.

Here are 8 Essential Facts about this ESSENTIAL substance.

1. Omega-3 is called “essential” because it’s necessary for our health, but we cannot make it on our own.

2. One essential Omega-3 fatty acid is a substance called α-linolenic acid (ALA). Our body can use ALA to make two other essential fatty acids: DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). However, we don’t make enough to meet daily needs for optimal health and the conversion of ALA to DHA and EPA is not efficient enough in most humans.

If you are deficient in Vitamin Bs of various kinds, Vitamin C, minerals like Magnesium and zinc you will not optimally convert ALA into DHA and EPA.

Have your physician test you for optimal levels of these nutrients and adjust your dietary plan and your supplement schedule to optimize the levels of these key supportive nutrients.

You may benefit from supplementation with:

a B complex containing activated forms of B vitamins,
a highly absorbable and bio-available form of magnesium (that does not cause diarrhea)
a highly absorbable and bio-available form of zinc
a highly absorbable and bio-available form of Vitamin C with bioflavanoids
A comprehensive Multivitamin and Multimineral supplement. If you’re a menstruating woman, you may wish to take the version that contains iron as well.

3. Omega-3 is critical for preventing symptoms of chronic illness, such as inflammation, chronic fatigue, joint and muscle pain and poor elimination of toxins.

4. The brain thrives on Omega-3. Without enough, we can experience learning problems, memory issues, brain fog, ADHD symptoms and other neurological symptoms. Proper levels help protect us from Alzheimer’s Disease. Balanced omega fatty acids are crucial in cardiovascular health and healthy blood pressure maintenance and insulin and blood sugar balance.

5. Food is a great source of Omega-3. Consider fatty fish like salmon, tuna, halibut, krill, flaxseed, walnuts and chia seeds (the latter 3 however give us ALA which needs to be converted to DHA & EPA).

6. It’s difficult to get sufficient amounts from food alone. Most Americans consume a daily average of 130 mg EPA + DHA – way below the recommended 1000-2000 mg. Consider adding a supplement to your diet. The Omega 3 supplement my family and I use, and I recommend to patients in my practice is International Fish Oil Standards (IFOS) five-star certified, which assures the highest level of purity, stability, and potency in fish oils. Each dose of this concentrated fish oil provides a whopping 900 mg of EPA and DHA in one softgel. Always check the the EPA and DHA content at the back of your bottle, as many times manufacturers will list a certain mg of fish oil on the front label of the fish oil bottle and it does not provide the accurate amounts of EPA and DHA that each serving has. This can mislead the buyer.

7. Acquiring Omega-3 must be done in a focused fashion, with attention paid to the balance between Omega-3 and Omega-6 (a group of fatty acids linked to increased inflammation). An imbalance can adversely impact well being and brain health.

8. Not all Omega 6s are bad! One known as DGLA (Dihomo-gamma-Linoleic Acid) is an antiinflammatory Omega 6 fatty acid. Other ones known as LA (Linoleic Acid) and AA (Arachindonic Acid) can be inflammatory in high amounts or when not in balanced amounts compared with DGLA.

In my testing I look at individual levels of these key Omega 3 and 6 Fatty Acids but also the ratio of Linoleic to DGLA as seen in the image above. A simple blood test can give me all of the above information.

Consult your Functional Medicine and / or Integrative Holistic Medicine physician to assess your intake, test your levels, and explore ways to help you protect your health and cognitive function with essential Omegas.

References:

University of Maryland CAM Database Online. “Omega-3 Fatty Acids” Accessed 7 Nov 2016: http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids
Assisi A., Banzi R., Buonocore C., et al. “Fish oil and mental health: the role of n-3 long-chain polyunsaturated fatty acids in cognitive development and neurological disorders.” Int Clin Psychopharmacol. 2006 Nov;21(6):319-36. Accessed 7 Nov 2016: https://www.ncbi.nlm.nih.gov/pubmed/17012979
Ricardo U., Dangour, A.D. “Nutrition in Brain Development and Aging: Role of Essential Fatty Acids” Nutrition Reviews (May 2006)64 (suppl 2) S24-S33; DOI: 10.1111/j.1753-4887.2006.tb00242.x http://nutritionreviews.oxfordjournals.org/content/64/suppl_2/S24
Bourre, J.M. “Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 2: macronutrients”. J Nutr Health Aging. 2006 Sep;10(5):386-99. Accessed 7 Nov 2016: http://www.bourre.fr/pdf/publications_scientifiques/260.pdf
NutritionData.com. Foods Highest in Total Omega-3 Fatty Acids. Accessed 7 Nov 2016. http://nutritiondata.self.com/foods-012140000000000000000.html?maxCount=20
Freund-Levi Y, Eriksdotter-Jonhagen M, Cederholm T, et al. “Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD study: a randomized double-blind trial.” Arch Neurol. 2006 Oct;63(10):1402-8. Accessed 7 Nov 2016: http://www.utdallas.edu/~tres/papers/freund-levi.2006.pdf

The information offered by this blog is presented for educational purposes. Nothing contained within should be construed as nor is intended to be used for medical diagnosis or treatment. This information should not be used in place of the advice of your physician or other qualified health care provider. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program. You should never disregard medical advice or delay in seeking it because of any information contained within this blog.
© Praana Integrative Medicine & Holistic Health Center, LLC. All rights reserved

Dr. Manisha Ghei April 16th, 2017

Posted In: Blog Post, Food, Functional Medicine, Integrative Medicine

Tags: ADHD, allergies, antioxidant, arthritis, asthma, blood pressure, cancer, cholesterol, Chronic fatigue syndrome, dementia, Diabetes Mellitus, fibromyalgia, functional medicine, healthy heart, heart healthy foods, Inflammation, Insulin, Memory, nutrition, Omega 3, vascular health

2 Comments

Seems like everyone’s talking about inflammation these days! More and more studies are coming out linking chronic inflammation to a vast majority of chronic diseases, even cancer.
But, is all inflammation bad?

Not at all! Some inflammation is absolutely necessary for our survival. It helps us overcome any acute insult or injury to the body. For example, if you cut your finger, cells are recruited to the wounded area, and through a very complex mechanism, the body heals itself quite efficiently. That’s an example of inflammation working to heal you.

Similarly, if you contract a bacterial infection, the body quickly produces inflammatory chemicals known as cytokines, which help kill the foreign invaders. During this fight between the bugs and your immune system, you feel terrible, but only for a short time. Soon, you’re up and on your merry way again with little long-term botheration from the incident.
It’s only when this inflammation becomes chronic or long term—like a low-grade smoldering fire which does not die out—that it leads to major problems.
Normally, during a period of low-grade inflammation, the body tries to warn us that something is wrong. It does this by producing many nagging signs and symptoms, like:

Aching of joints and muscles
High blood pressure
Rising blood sugars
Headaches
Sleep issues
Allergies
Skin issues
Frequent abdominal pain and other gut issues
Mood swings
Difficulty with sleep
Low energy levels

If we do not heed these symptoms and allow the inflammation to persist unchecked, after years (yes, years!), the inflammation becomes evident in the form of a heart attack, stroke, Alzheimer’s disease, cancer, or an autoimmune disease like multiple sclerosis, ulcerative colitis or rheumatoid arthritis, which can no longer be ignored by us.
Some signs of chronic inflammation are:

Chronic fatigue and low energy.
Mood issues including anxiety, depression, and panic attacks.
Memory problems, brain fog, or loss of focus.
Difficulty falling asleep, waking up in the middle of the night, or unrestful sleep.
Gut symptoms including acid reflux, IBS, constipation, diarrhea, blood or mucus in stools, intermittent abdominal pain, gas and bloating.
Chronic muscle and joint pain, swelling, redness.
Chronic allergies and asthma requiring frequent medications.
Chronic skin issues like eczema, psoriasis, redness of face and cheeks, or hives.
Frequent or daily headaches, tremors, easy loss of balance, tingling and pain along nerves in the extremities, dizziness.
High blood pressure.
Metabolic syndrome, abdominal obesity, or diabetes mellitus.
Low bone density or osteoporosis.
Heart disease, peripheral vascular disease.
Diagnosis of cancer: Yes, taking action is possible even after being diagnosed with a cancer as you can still try to prevent future development of new cancers at other sites.

What should you do if you have any any signs of chronic inflammation?
1. Find a functional medicine physician who is well versed in evaluating your symptoms.
This person can help you eliminate the root cause of the chronic inflammation, rather than focusing on just suppressing symptoms.
2. Avoid all inflammatory foods.
This includes refined sugars, sugar substitutes, juices and sodas, trans-fats, dairy products, non-organic eggs and meats from grain fed animals. I also suggested you eliminate any foods to which you may be sensitive/ allergic, all GMO foods, and foods with a high glycemic index.
3. Eat real foods.
Incorporate large amounts of antioxidants, phytochemicals, and fiber-rich fruits and vegetables, nuts and seeds, small amounts of grass fed meats and wild small fish, healthy spices like turmeric, ginger, garlic, and herbs like cilantro, parsley, oregano and rosemary in your diet.
4. Stop eating microwavable lunches or dinners.
Don’t eat dead packaged and processed foods which have no life force!
5. Sip green tea on a regular basis.
It cuts inflammation and calms the mind!
6. Try to avoid toxins as much as possible in your daily life.
You’ll give your liver a much-needed break.
7. Incorporate a daily exercise regimen.
Do yoga, tai chi or some other form of movement exercise. Move the body whenever you get a chance!
8. Meditate daily and breathe deeply.
Who doesn’t love peace of mind? It’s also great for your nervous system.
9. Focus on optimal sleep.
Your body restores and regenerates itself daily when you sleep!
10. Find time for rest and rejuvenation on a regular basis.
Try to make time for mini-vacations and spending time in nature!
11. Get regular massages.
Better yet: learn the technique of self-massage and practice it daily!
12. Get your vitamin D levels checked and maintain optimal levels.
Use supplements if needed. Vitamin D is not just a vitamin, it functions as a hormone messenger molecule in crucial body processes!
13. Maintain a positive mental attitude about life and people!
Remember, just like your gut affects the brain, the brain in turn affects the gut, where the majority of our neurotransmitters are made.
Cutting down your risk of inflammation will most certainly reduce your chances of developing chronic diseases, so I urge you to take corrective action, one baby step at a time.

This blog was first published on MindBodyGreen

The information offered by this blog is presented for educational purposes. Nothing contained within should be construed as nor is intended to be used for medical diagnosis or treatment. This information should not be used in place of the advice of your physician or other qualified health care provider. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program. You should never disregard medical advice or delay in seeking it because of any information contained within this blog.

websol November 1st, 2015

Posted In: Blog Post

Tags: allergies, asthma, blood pressure, cancer, chronic disease, chronic fatigue, Chronic fatigue syndrome, fibromyalgia, functional medicine, heart health, holistic medicine, Inflammation, integrative medicine, metabolic syndrome, osteoporosis, toxins

1. Triglyceride to HDL ratio

This is a simple measure of insulin resistance, risk for diabetes mellitus type 2 and cardiovascular disease. A ratio less than 3.0 is considered normal, and more than or equal to 3.0 is suggestive of insulin resistance. An elevated ratio should prompt counseling the patient about therapeutic lifestyle change with close follow-up of metabolic markers for prevention of development of diabetes, hypertension and coronary artery disease.

2. Fasting insulin levels (and, if possible, two-hour postprandial insulin levels)

Usually at the yearly physical your physician will measure fasting blood sugar, and may even measure hemoglobin A1c levels, which are markers for pre-diabetes and diabetes. In my opinion, abnormalities in these are late developments. Insulin is a hormone produced by cells in the pancreas; it’s responsible for regulating blood sugar levels and for promoting uptake of glucose into the cells for use as energy or for storage as fat. Measuring insulin levels two hours after a glucose load may be the first indication of metabolic problems in your handling of sugar (or carbs).

Sometimes a two-hour insulin measurement may be difficult, so in my practice I measure fasting insulin levels, which are the second measure to go up. These two can be early markers of insulin resistance, much before fasting blood sugar starts going up. Excessive insulin levels lead to increased serum triglyceride levels, decreased serum HDL (good cholesterol) levels, increase in levels of the small dense LDL (the plaque-promoting form of bad cholesterol) particles. Insulin resistance is a risk factor for hyperlipidemia, diabetes, hypertension, all of which contribute to atherosclerosis and plaque formation, which in turn is a risk factor for heart disease development. I encourage my patients to work toward a fasting insulin level of at least less than 6 microunits per mL (ideal is 4). Obviously diet is the key for reducing Insulin levels, but for patients who need additional short or long term support, I use a supplement known as Blood Sugar Support which have all the key factors to support blood sugar and insulin levels. It has helped many of my patients.

3. High-sensitivity C-reactive protein (hsCRP)

CRP is produced in the liver in response to nonspecific inflammation in the body. The high-sensitivity CRP is an assay which detects low levels of CRP specific to inflammation in the blood stream i.e., vascular inflammation, which could be the cause for development and progression of heart disease. Standard lipid tests do not test for inflammation, and this marker can be easily tested through your local labs. Even if your lipid profile is normal and you do not have other cardiovascular disease risk factors like hypertension or obesity or diabetes, if this marker is elevated, it is cause for concern. If somebody has already had a cardiac event like a heart attack or stroke, and this marker stays chronically elevated, it could be predictive of a high risk for future repeat heart attack or stroke. The therapeutic goal for hs-CRP is less than 0.7 mg/L, preferably as near to 0 as possible. I like to repeat this a few times to be sure it is actually staying high.

A word of caution with hs-CRP: though a marker of inflammation, it can also be a marker for infection and acute injury, so if you’ve had any recent surgery or procedure; have a respiratory, gum or other infection; or have the flu, please wait until your symptoms are resolved before testing, as this marker will be elevated due to that acute event.

4. Red blood cell magnesium levels

Red blood cell magnesium levels are the best way to assess magnesium status. Clinical signs of magnesium deficiency could be fatigue, weakness, muscle cramps, seizures, numbness and tingling in the extremities, mood and sleep issues, irregular heartbeats and also spasms in the arteries which feed the heart, contributing to heart attacks. Magnesium supplementation may reduce the risk of coronary heart disease, so try to keep levels at the high end of the lab range, though I monitor clinically more often. The form of magnesium I use is a very highly absorbable chelate.

5. Homocysteine levels

Homocysteine is a toxic amino acid and elevated levels can be a risk factor for development of cardiovascular disease and stroke. Elevated homocysteine levels damage LDL cholesterol, causing its oxidation. Oxidized LDL leads to plaque formation in the coronary arteries. Homocysteine is produced as an intermediate in the metabolism of amino acids methionine and cysteine. Activated forms of vitamin B12 and folate are needed for the conversion of homocysteine into methionine, so elevated homocysteine can be one of the indicators of deficiency in these important vitamins (remember that there are drugs like Methotrexate and acid blockers like Nexium which block the metabolism or absorption of these vitamins and may cause elevations in homocysteine levels). Serum homocysteine is great screening test for patients who are at a risk for cardiovascular disease and stroke, especially when there is a family history but no other known risk factors. Strive to keep levels around 8 micromoles/L. If elevated Homocysteine levels are due to a genetic variation in key enzymes of the methylation pathway then supplementation will usually be required long-term with frequent (every 3 months) monitoring of levels.

6. Ferritin levels

Ferritin is an iron-containing protein produced in the liver, and signifies the stored form of iron. Ferritin can also be a marker of inflammation. Moderate elevation of ferritin may lead to a 2-3 times increased risk for development of diabetes. Though the normal range in your lab for ferritin can be from 12-150 ng/mL in women and 12-300 ng/mL in males, studies have shown high ferritin levels increase cardiovascular risk. Lowering the iron stores to near optimal level of between 70-80ng/mL will improve outcomes in cardiovascular disease including reduced risk for heart attacks, strokes and also improve life expectancy. As a side note, I don’t think that ferritin levels less than 50ng/mL are in any way normal (even though your lab may show it in the normal range) and reasons for low iron stores must be looked into.

7. Testosterone levels (in males only — no correlation with heart disease has been found in women)

In males, testosterone deficiency has been associated with a high risk for cardiovascular disease. In elderly males, lower free testosterone level has been shown to be associated with a high prevalence of cardiovascular disease. If your total and free testosterone levels are low, work within integrative or a functional medicine physician to find out why that is the case. Replacing testosterone may not be the only answer. Certain natural supplements like Zinc, Magnesium, L-carnitine, B vitamins especially B6 can help support Testosterone levels naturally.

Males should try to keep testosterone levels between 350-600ng/dl. Remember, more is not always better with testosterone therapy if you need it, and always seek out a physician well versed in male hormonal replacement therapies, or someone who can help guide you to support your body’s hormone production naturally!

8. Testing for chronic infections

Many pathogenic bugs have been shown to have a significant correlation with development of coronary heart disease as well as acute coronary syndromes (heart attacks). Some of these are herpes simplex virus, cytomegalovirus, and H. pylori. Ask your physician to test for antibodies to these bugs through your local laboratories. Since most of your immune system is in the gut, taking a multistrain good quality probiotic can be a great first step.

Print out and take this list to your physician to help them better evaluate your risk for heart disease, or find a functional medicine physician who is well versed in managing and counseling patients with metabolic disorders!

Dr. Manisha Ghei first wrote this article for Mind Body Green

The information offered by this blog is presented for educational purposes. Nothing contained within should be construed as nor is intended to be used for medical diagnosis or treatment. This information should not be used in place of the advice of your physician or other qualified health care provider. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program. You should never disregard medical advice or delay in seeking it because of any information contained within this blog.

websol September 20th, 2015