Insulin resistance

[Mary Ann Butler]

I have a 57 YO female highly motivated, Natural path patient, I have been seeing for peptide and hormone therapy. Her primary concerns when coming to me last year were PCOS and insulin resistance. This last visit she expressed concern for CVD as it runs on her mother side of the family. She ordered her own labs and reported an elevated calcium score. She states last year her calcium score was zero and this time it is 33. She is concerned it is trending upward. Also, she is concerned that her insulin is also trending upward although reports being diligent in avoiding sugar and carbs. She reports her Ketones range from 1.26 to 2.0 but her fasting glucose will sometimes still be in the 90’s. She reports am fasting glucose of 103 mg/dl. This is not my area of expertise. So, I do not know why one would have an elevated fasting blood glucose and be in ketosis. Or, why someone who exercises regularly, reports eating low carb, has a weight of 110 lbs and 5’3” would have a total cholesterol of 240 mg/dl and LDL of 123 mg/dl.
Last year she started MOTs-C for insulin at the recommended 10mg weekly in divided dose. She has remained on MOTs-C at 2mg weekly in divided doses. She developed welts with CJC/Ipamorelin so we changed her to Ipamorelin alone 0.05 QHS. She has been taking 5-amino 1MQ 3 caps daily x 6 months taking 1 month off after 3 months on. She now reports she feels they are no longer working. She also has been on TA1 starting with a daily dose of 0.15 ml daily for 12 weeks then 0.15 ml twice a week. and BPC-157 starting at 300 mcg daily for 12 weeks now taking 300 mcg twice weekly. She recently started NAD nasal spray at her request.
She had COVID19 in February. Mild symptoms but has not felt great since.
I am working with her to get her estradiol level optimal. However, she is very sensitive to the hormones. ℅ breast tenderness, bloating, and vaginal bleeding/spotting. I have her on 250 mg of micronized progesterone. She also uses 5mg of testosterone cream. Any higher and she reports feeling “thick”. I also find her Free T3 is not optimized as it is only 2.5 pg/ml and I am encouraging her to increase her desiccated thyroid to 90 mg daily.

Labs:
5/27/20.         9/16/20               4/26/21
FBG          100                   82                         88
Insulin     3.1                     2.8                        5.1
S-CRP      0.5                    n/a                        1.5
Hgb A1C  5.1                     n/a                        4.8
Ferritin   28                      n/a                        24
Iron         93                      n/a                        168
Ttl Chol   251                    n/a                       240
LDL         133                    n/a                        123
HDL        103                    n/a                        97

Any input is appreciated. Should she be concerned since she is watching her diet and exercising along with the above peptides. Would it be advisable to come off the MOTs-C for a while. Could it be lowering the insulin and not the glucose? Could the higher glucose in the presence of low insulin be a picture of insulin resistance? If yes, then what? liraglutide?

[Abid Husain]

Hello Mary Ann,

This is a great case with a lot to possibly discuss.  I can contribute to the CVS component.  With an increase in her calsium score, there are two possible  scenarios.  1. She had soft and mildly active plaque that has condensed, stabilized and now calcified.  Thats a good thing.  2. This current increase in her hs-CRP and calcification are secondary to COVID.  I am finding that COVID is an infection of the endothelium.  All the areas that have high vasculature or dependence on endothelial function are highly affected.

The next thing I would do is to check a NMR lipid partical size breakdown, Lp(a), oxidixed LDL, F2Isoprostane, Myeloperoxidase,  ADMA.  If those inflammatory markers are elevated, there is an active coronary process going on and more aggressive lipid therepy needs to be started.

I am doubtful that she has insulin resistance, as there must be high insulin for that to happen.

Abid

[Kristelle Reyes]

Hello @byurthgmail-com @drerikaeshealth-com any thoughts on this case study? 🙂

[Mary Ann Butler]

Thank you very much Dr. Husain. I thought it an interesting case also. I will check her NMR lipid as you recommend.

 

[Erika Schwartz]

Hello Mary Ann,

I would focus on getting her hormones and thyroid in balance. I would be very happy to look at her most recent blood results and the protocols you are using on her. From my experience, women in her age group benefit the most from achieving optimum hormone balance and then adding peptides.

Please let me know how I can help.

All the best,

Erika

[Kristelle Reyes]

Hello @maryannwellness-firm-com  Just making sure you got Dr. Schwartz’ response 🙂

[Mary Ann Butler]

Dr. Schwartz.

I would love to have your input. If you will leave me an email I will take you up on your offer.

Thank you so much!

[Kristelle Reyes]

Claim your CME here: https://earnc.me/ocTg3A

[Leonard Pastrana]

@maryannwellness-firm-com any updates on this case? Just came across is it. Did you try a GLP-1?

[Berna]

I would consider that if she is very sensitive to hormones, she may have a problem with detoxification. I would check her homocysteine level as well and support her detoxification pathways if you have not done so already. Increased allostatic load would result in excess free radicals/oxidative stress and could lead to the dyslipidemia and other metabolic alterations you are seeing. The hormone issue is probably only a downstream effect from her detoxification issues.

[Mary Ann Butler]

Thank you Dr. Berna

[Giovanni Silva]

Regarding the high cholesterol and LDL, recent cohort studies have demonstrated an inverse association between BMI and LDL-C in individuals on carb-restricted diets and are identified as “Lean Mass Hyper-Responders”. LMHR exhibit exceptional increases in LDL-C, in the context of low triglycerides and high HDL-C.

Also, hugely agree with Abid….NMR LipoProfile much more indicative for possible future CVD.

I would also check for liver detox pathways. Looking at her lab results, it appears her liver may need to be addressed.

[Mary Ann Butler]

Thank you, Dr. Silva. (:

[Giovanni Silva]

Meant to share this also:

https://pubmed.ncbi.nlm.nih.gov/23973920/

“Level of ALT was associated with levels of ApoB, concentration and particle size of very low-density lipoproteins (VLDL), concentration of LDL particles (LDL-P), and percentages of small dense LDL (sdLDL) and sdLDL-cholesterol(sdLDL-C) (P<.0001 for all). High-normal level of ALT was associated with higher levels of LDL-cholesterol, LDL-P, sdLDL-C, and sdLDL particles (P<.001 for all).”

Low-normal ALT: less than 19IU/L in women and less than 31IU/L in men.

High-normal ALT: between 19-40IU/L in women and 31-40IU/L in men.

Elevated ALT: greater than 40IU/L in either men or women.

My “optimal” (in contrast to “reference”) ranges are:

Women: 10-19IU/L

Men: 13-22IU/L

-if high, I think digestion of fat and detox (phase 1 & 2).

-phase 3: mobilization/elimination

 

[Anthony Castore]

• For insulin resistance the combination inhabe had the most success with is:
• 5mg MOTSc/day
• 10mg SS31 every 3 days
• Methylene Blue
• Microdose of NAD+ W/apigenin to down regulate CD38
• Sauna for heat shock protein
• 10min AM red light exposure
• 100mg 5-amino-1MQ am 50mg early afternoon
• Spermadine 2mg a day

Nutritional supplements: GI restore by Nutradyn 5with biggest carb meal

Methylation support to support motsC

Alpha lipoic acid and Tyrosine in the morning

[Author]

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