A4M STUDY EXAMS GUIDE ANSWERS AND
QUESTIONS SET A+
✔✔s/s of elevated DHEA - ✔✔acne
anger
deeper voice
depression
facial hair
fatigue
insomnia
irritability
mood changes
restless sleep
sugar cravings
weight gain
causes of elevated DHEA levels? long term stress, adrenal tumor, too high of DHEA
dose
✔✔therapeutic benefits of DHEA - ✔✔stress
weight loss
hypercholesterolemia
hypertriglyceridemia
insomnia
insuline resistance/diabetes
sexual dysfunction
coronary heart disease
cognition
osteopenia/osteoporosis
depression
RA
AS
lupus
insomnia
menopause
,✔✔DHEA in males - ✔✔Recommended daily dosage: 10-100 mg PO SR. may be used
PO or transdermally
Contraindicated in prostate cancer
✔✔severity of insulin resistance - ✔✔If FBS high-normal (over 85 mg/dL) the risk of the
patient dying of cardiovascular disease is increased by 40%. Also increased risk of
vascular death. May account for a 6 to 10% decrease in the volume of the hippocampus
and amygdala.
Insulin resistance is a risk factor for cognitive decline.
✔✔symptoms of insulin resistance - ✔✔fuzzy brain, infertility, irregular menstrual cycles,
irritability, loose bowel movements alternating with constipation, water retention, weight
gain
✔✔Causes of insulin resistance - ✔✔genetic susceptibility, eating processed foods,
increased stress, excessive caffeine intake, abuse of alcohol, nicotine, excessive
dieting, oral contraceptives, lack of exercise, decreased estrogen in females, increased
testosterone in males, increases testosterone in females, decreased testosterone in
males, excessive progesterone in females (prescribed), insomnia, elevated DHEA
levels, hypothyroidism
✔✔insulin resistance treatment conventional therapy - ✔✔exercise, low GI diet, weight
reduction, metformin
✔✔insulin resistance treatment functional medicine - ✔✔Exercise- 4 hours per week
Low GI diet
Good fats
High fiber- soluble fiber has been shown to lower insulin levels
Get enough protein in the diet- protein content of food also decreases the absorption of
sugars
Weight loss if the patient is overweight
Good sleep hygiene. If patient does not sleep at least 6.5 hours a night and/or does not
get restorative sleep, then insulin levels may rise
Nutritional supplements: chromium, ALA, mag, vanadium, vit D, EPA/DHA, CLA, vit E, L
carnitine/carnosine/taurine/arginine, vit E
Botanical supplements: berberine, ginseng, fenugreek, bitter melon, psyllium, aloe vera,
nopal, gymnema, bilberry, cinnamon, green tea, olive leaf extract 500 mg BID, green
coffee bean extract, pycnogenol, ivy gourd
✔✔low GI eating program - ✔✔High GI foods increase the production of E and NE,
which decrease insulin sensitivity
The GI is affected by the size of the particles into which the food breaks down into.
Therefore, the more processed the food or the longer its cooked, the higher its glycemic
index
,The best carbs that curb insulin are: broccoli, lentils and chickpeas
✔✔chromium - ✔✔600 mcg to 1,600 mcg qd with normal renal function- needed for
carb and lipid metabolism. increases the number of insulin receptors.
✔✔Alpha-Lipoic Acid (ALA) - ✔✔300-400 mg q day. Fat and water soluble and is a
broad spectrum antioxidant. Functions as a coenzyme in carb metabolism. .
✔✔magnesium - ✔✔400- 600 mg qd. Essential cofactor in glucose oxidation. Modulates
glucose transport across cell membranes. Deficiency associated with insulin resistance.
✔✔Vanadium - ✔✔essential trace mental. 10-50 mcg. Improves insulin sensitivity.
Exacerbations of bipolar disorder may be a side effect.
✔✔vitamin D - ✔✔low levels associated with insulin resistance and beta-cell
dysfunction.
✔✔omega 3 FA - ✔✔2,000 mg qd. EPA/DHA has a beneficial effect on plasma insulin
and lipid concentrations in animals
✔✔CLA (conjugated linoleic acid) - ✔✔1000 mg qd. Only naturally occurring trans-fat.
Normalizes impaired glucose tolerance and improves hyperinsulinemia.
✔✔vitamin E - ✔✔improves glucose tolerance and reduces glycosylation. Measure
vitamin E levels and supplement as needed.
✔✔biotin - ✔✔deficiency results in an impairment of glucose utilization
✔✔amino acid supplementation for insulin resistance - ✔✔L Carnosine 1000 mg qd with
normal renal function. A nutrient which is a combo of two AA, beta alanine and histidine.
An antioxidant and aids the body by preventing glycation. Found in the brain, skeletal
muscles, heart, and lens of the eye.
L Taurine 1,000-2,000 mg q day with normal renal function. An amino acid. Requires
zinc to help it function properly. Positive effect on insulin sensitivity and helps to control
BG. stress depletes the body of taurine.
L Arginine 1,000 mg a day with normal renal function. Helps insulin sensitivity. Use with
caution when giving to patients with heart valves that are not functioning optimally.
✔✔L-carnitine - ✔✔1,000-2,000 mg a day with normal renal function. Measure TMAO
levels before giving large doses long term. An antioxidant that influences free FA and
glucose oxidation. May improve diabetic neuropathy.
✔✔Berberine - ✔✔200-500 mg BID to TID. can cause uterine contractions- do not use
in pregnancy. Can cause GI upset.
, ✔✔Ginseng (Panax, Asian) - ✔✔100-400 mg of extract standardized to 4%
ginsenosides. Species contain triterpenoid glycosides that lower BG by regulating
hepatic glucose uptake, glycogen synthesis, and insulin release. Has been shown to
reduce PP glycemia in T2DM and non diabetics.
✔✔Fenugreek - ✔✔(Trigonella foenum graecum)
Seeds have hypoglycemic effect due to high content of soluble fiber which decreases
the rate of gastric emptying and delays the absorption of glucose from the small
intestine. Lowers cholesterol and triglycerides. Potential cross reaction if patient is
allergic to chickpeas. Possible SE: diarrhea, flatulence, dizziness. Can contain coumarin
derivatives so a theoretical risk that PT or INR might be increased. Take minerals and
medications separately from fenugreek containing products. May precipitate
hypokalemia when used in combo with some laxatives or meds that lower potassium.
Also decreases in the serum level of T3 and in the T3/T4 ratio, as well as an increase in
the level of T4 have occurred in animals given fenugreek. Do thyroid studies on patients
taking this supplement.
✔✔Bitter Melon - ✔✔(Momordica charantia). Tropical fruit also called bitter gourd.
Increased insulin secretion, increased glucose oxidation, and decreased hepatic
gluconeogenesis. Active components: charantin, vicine and polypeptide-p (an insulin
like protein). More potent hypoglycemic agent than tolbutamide in one study.
✔✔Aloe vera - ✔✔improved BG control in one study
✔✔Nopal (optunia streptacantha) - ✔✔also called prickly pear cactus. High in fiber and
pectin. Hypoglycemic effect
✔✔Gymnema Sylvestre - ✔✔herb endemic to India, common name means sugar
destroying. Show in clinical trials to lower blood sugar.
✔✔Cinnamon, cloves, bay leaves - ✔✔spices have insulin like or insulin potentiating
action in vitro. Possible side effects of cinnamon: GI upset, stomatitis, perioral dermatitis
✔✔green tea - ✔✔Insulin enhancing activity through predominant active ingredient
EGCG. EGCG protected cytokine induced B cell damage, which is partly mediated by
suppression of iNOS activity
✔✔olive leaf extract - ✔✔Contain oleuropein which has been shown to lower blood
sugar. Slows the digestion of starches into simple sugars and slows absorption of
simple sugars from the intestine. Increases the uptake of glucose into tissues from the
blood and lowers fasting insulin levels. Use 500 mg q day- shown to lower HGBA1c.
✔✔green coffee bean extract - ✔✔Shown to work like metformin in lowering blood
sugar. Lowers after meal glucose surges.
QUESTIONS SET A+
✔✔s/s of elevated DHEA - ✔✔acne
anger
deeper voice
depression
facial hair
fatigue
insomnia
irritability
mood changes
restless sleep
sugar cravings
weight gain
causes of elevated DHEA levels? long term stress, adrenal tumor, too high of DHEA
dose
✔✔therapeutic benefits of DHEA - ✔✔stress
weight loss
hypercholesterolemia
hypertriglyceridemia
insomnia
insuline resistance/diabetes
sexual dysfunction
coronary heart disease
cognition
osteopenia/osteoporosis
depression
RA
AS
lupus
insomnia
menopause
,✔✔DHEA in males - ✔✔Recommended daily dosage: 10-100 mg PO SR. may be used
PO or transdermally
Contraindicated in prostate cancer
✔✔severity of insulin resistance - ✔✔If FBS high-normal (over 85 mg/dL) the risk of the
patient dying of cardiovascular disease is increased by 40%. Also increased risk of
vascular death. May account for a 6 to 10% decrease in the volume of the hippocampus
and amygdala.
Insulin resistance is a risk factor for cognitive decline.
✔✔symptoms of insulin resistance - ✔✔fuzzy brain, infertility, irregular menstrual cycles,
irritability, loose bowel movements alternating with constipation, water retention, weight
gain
✔✔Causes of insulin resistance - ✔✔genetic susceptibility, eating processed foods,
increased stress, excessive caffeine intake, abuse of alcohol, nicotine, excessive
dieting, oral contraceptives, lack of exercise, decreased estrogen in females, increased
testosterone in males, increases testosterone in females, decreased testosterone in
males, excessive progesterone in females (prescribed), insomnia, elevated DHEA
levels, hypothyroidism
✔✔insulin resistance treatment conventional therapy - ✔✔exercise, low GI diet, weight
reduction, metformin
✔✔insulin resistance treatment functional medicine - ✔✔Exercise- 4 hours per week
Low GI diet
Good fats
High fiber- soluble fiber has been shown to lower insulin levels
Get enough protein in the diet- protein content of food also decreases the absorption of
sugars
Weight loss if the patient is overweight
Good sleep hygiene. If patient does not sleep at least 6.5 hours a night and/or does not
get restorative sleep, then insulin levels may rise
Nutritional supplements: chromium, ALA, mag, vanadium, vit D, EPA/DHA, CLA, vit E, L
carnitine/carnosine/taurine/arginine, vit E
Botanical supplements: berberine, ginseng, fenugreek, bitter melon, psyllium, aloe vera,
nopal, gymnema, bilberry, cinnamon, green tea, olive leaf extract 500 mg BID, green
coffee bean extract, pycnogenol, ivy gourd
✔✔low GI eating program - ✔✔High GI foods increase the production of E and NE,
which decrease insulin sensitivity
The GI is affected by the size of the particles into which the food breaks down into.
Therefore, the more processed the food or the longer its cooked, the higher its glycemic
index
,The best carbs that curb insulin are: broccoli, lentils and chickpeas
✔✔chromium - ✔✔600 mcg to 1,600 mcg qd with normal renal function- needed for
carb and lipid metabolism. increases the number of insulin receptors.
✔✔Alpha-Lipoic Acid (ALA) - ✔✔300-400 mg q day. Fat and water soluble and is a
broad spectrum antioxidant. Functions as a coenzyme in carb metabolism. .
✔✔magnesium - ✔✔400- 600 mg qd. Essential cofactor in glucose oxidation. Modulates
glucose transport across cell membranes. Deficiency associated with insulin resistance.
✔✔Vanadium - ✔✔essential trace mental. 10-50 mcg. Improves insulin sensitivity.
Exacerbations of bipolar disorder may be a side effect.
✔✔vitamin D - ✔✔low levels associated with insulin resistance and beta-cell
dysfunction.
✔✔omega 3 FA - ✔✔2,000 mg qd. EPA/DHA has a beneficial effect on plasma insulin
and lipid concentrations in animals
✔✔CLA (conjugated linoleic acid) - ✔✔1000 mg qd. Only naturally occurring trans-fat.
Normalizes impaired glucose tolerance and improves hyperinsulinemia.
✔✔vitamin E - ✔✔improves glucose tolerance and reduces glycosylation. Measure
vitamin E levels and supplement as needed.
✔✔biotin - ✔✔deficiency results in an impairment of glucose utilization
✔✔amino acid supplementation for insulin resistance - ✔✔L Carnosine 1000 mg qd with
normal renal function. A nutrient which is a combo of two AA, beta alanine and histidine.
An antioxidant and aids the body by preventing glycation. Found in the brain, skeletal
muscles, heart, and lens of the eye.
L Taurine 1,000-2,000 mg q day with normal renal function. An amino acid. Requires
zinc to help it function properly. Positive effect on insulin sensitivity and helps to control
BG. stress depletes the body of taurine.
L Arginine 1,000 mg a day with normal renal function. Helps insulin sensitivity. Use with
caution when giving to patients with heart valves that are not functioning optimally.
✔✔L-carnitine - ✔✔1,000-2,000 mg a day with normal renal function. Measure TMAO
levels before giving large doses long term. An antioxidant that influences free FA and
glucose oxidation. May improve diabetic neuropathy.
✔✔Berberine - ✔✔200-500 mg BID to TID. can cause uterine contractions- do not use
in pregnancy. Can cause GI upset.
, ✔✔Ginseng (Panax, Asian) - ✔✔100-400 mg of extract standardized to 4%
ginsenosides. Species contain triterpenoid glycosides that lower BG by regulating
hepatic glucose uptake, glycogen synthesis, and insulin release. Has been shown to
reduce PP glycemia in T2DM and non diabetics.
✔✔Fenugreek - ✔✔(Trigonella foenum graecum)
Seeds have hypoglycemic effect due to high content of soluble fiber which decreases
the rate of gastric emptying and delays the absorption of glucose from the small
intestine. Lowers cholesterol and triglycerides. Potential cross reaction if patient is
allergic to chickpeas. Possible SE: diarrhea, flatulence, dizziness. Can contain coumarin
derivatives so a theoretical risk that PT or INR might be increased. Take minerals and
medications separately from fenugreek containing products. May precipitate
hypokalemia when used in combo with some laxatives or meds that lower potassium.
Also decreases in the serum level of T3 and in the T3/T4 ratio, as well as an increase in
the level of T4 have occurred in animals given fenugreek. Do thyroid studies on patients
taking this supplement.
✔✔Bitter Melon - ✔✔(Momordica charantia). Tropical fruit also called bitter gourd.
Increased insulin secretion, increased glucose oxidation, and decreased hepatic
gluconeogenesis. Active components: charantin, vicine and polypeptide-p (an insulin
like protein). More potent hypoglycemic agent than tolbutamide in one study.
✔✔Aloe vera - ✔✔improved BG control in one study
✔✔Nopal (optunia streptacantha) - ✔✔also called prickly pear cactus. High in fiber and
pectin. Hypoglycemic effect
✔✔Gymnema Sylvestre - ✔✔herb endemic to India, common name means sugar
destroying. Show in clinical trials to lower blood sugar.
✔✔Cinnamon, cloves, bay leaves - ✔✔spices have insulin like or insulin potentiating
action in vitro. Possible side effects of cinnamon: GI upset, stomatitis, perioral dermatitis
✔✔green tea - ✔✔Insulin enhancing activity through predominant active ingredient
EGCG. EGCG protected cytokine induced B cell damage, which is partly mediated by
suppression of iNOS activity
✔✔olive leaf extract - ✔✔Contain oleuropein which has been shown to lower blood
sugar. Slows the digestion of starches into simple sugars and slows absorption of
simple sugars from the intestine. Increases the uptake of glucose into tissues from the
blood and lowers fasting insulin levels. Use 500 mg q day- shown to lower HGBA1c.
✔✔green coffee bean extract - ✔✔Shown to work like metformin in lowering blood
sugar. Lowers after meal glucose surges.
