Diabetes

 

Disclaimer: The information contained within this podcast, notes and website are for educational purposes only and are not to be considered as a substitute for sound medical or health advice. The use of the information contained herein is at the discretion and risk of the user.

Diabetes is a chronic condition that affects how your body processes blood sugar (glucose). There are several types of diabetes, including type 1, type 2, gestational diabetes, and others. Type 1 diabetes is an autoimmune condition where the immune system attacks and destroys insulin-producing cells in the pancreas. Type 2 diabetes occurs when the body becomes resistant to insulin or doesn’t produce enough insulin to maintain normal glucose levels. Gestational diabetes develops during pregnancy and usually resolves after childbirth. Other types of diabetes include monogenic diabetes and secondary diabetes caused by other medical conditions or medications.

Diet plays a crucial role in managing diabetes, especially type 2 diabetes. A balanced diet that includes whole grains, fruits, vegetables, lean proteins, and healthy fats can help control blood sugar levels. Monitoring carbohydrate intake is essential for people with diabetes as carbohydrates have the most significant impact on blood sugar levels. Sleep is also important for managing diabetes as inadequate sleep can affect insulin sensitivity and glucose metabolism. Stress can lead to elevated blood sugar levels as stress hormones can interfere with insulin function. Pollution and inflammation have been linked to an increased risk of developing type 2 diabetes, although more research is needed to fully understand these relationships. Genetics play a significant role in the development of type 2 diabetes, with family history being a risk factor for the condition. Autoimmune factors contribute to type 1 diabetes, where the immune system mistakenly attacks insulin-producing cells. Hormonal imbalances, such as those related to cortisol and growth hormone, can affect blood sugar regulation. Adequate intake of certain vitamins and minerals, such as vitamin D and magnesium, may play a role in preventing or managing type 2 diabetes. Blood tests are essential for diagnosing and monitoring diabetes. Key tests include fasting blood sugar, hemoglobin A1c, oral glucose tolerance test, and others to evaluate blood sugar control over time.

There are several different forms of diabetes, each with its own unique characteristics and causes. Here are the main forms of diabetes:

  1. Type 1 Diabetes: This is an autoimmune disease in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin, a hormone that regulates blood sugar levels. Type 1 diabetes typically develops in childhood or adolescence, and people with this condition need to take insulin injections to control their blood sugar levels.
  2. Type 2 Diabetes: This is the most common form of diabetes, accounting for about 90% of all cases. Type 2 diabetes is caused by a combination of insulin resistance (when the body’s cells become less responsive to insulin) and impaired insulin secretion. It is often linked to lifestyle factors such as obesity, physical inactivity, and an unhealthy diet.
  3. Gestational Diabetes: This form of diabetes develops during pregnancy, and is caused by hormonal changes and insulin resistance. Gestational diabetes typically goes away after pregnancy, but women who have had gestational diabetes are at a higher risk of developing type 2 diabetes later in life.
  4. LADA (Latent Autoimmune Diabetes in Adults): This is a form of type 1 diabetes that develops in adults, and is characterized by a slow progression from insulin resistance to a complete loss of insulin production.
  5. Maturity-Onset Diabetes of the Young (MODY): This is a rare form of diabetes that is caused by genetic mutations that affect insulin production. MODY is typically diagnosed in young adulthood and is often treated with lifestyle changes and/or oral medications.
  6. Secondary Diabetes: This form of diabetes is caused by a medical condition or medication that interferes with insulin production or blood sugar regulation. Examples of secondary diabetes include diabetes caused by pancreatitis, pancreatic surgery, or certain medications such as steroids.
  7. Monogenic Diabetes: This is a rare form of diabetes that is caused by a single genetic mutation. Monogenic diabetes can be diagnosed in infancy or childhood, and is often treated with lifestyle changes and/or oral medications.

Type II diabetes requires a comprehensive nutrition approach that focuses on maintaining stable blood sugar levels through a balanced diet rich in fiber, whole grains, lean proteins, and healthy fats. Additionally, incorporating regular physical activity into one’s routine is crucial for managing weight and improving insulin sensitivity. Adequate sleep is also essential as it helps regulate hormones that control blood sugar levels. Dietary modifications such as reducing sugar and refined carbohydrate intake, along with portion control, are key components of managing type II diabetes. Nutritional supplements like magnesium, chromium, and alpha-lipoic acid may also aid in blood sugar regulation. Detoxification strategies can support overall health by reducing the body’s toxic burden, potentially benefiting individuals with type II diabetes.

Genetic Causes

Genetics can play a significant role in the development of diabetes. People with a family history of diabetes are more likely to develop the condition, especially if there is a first-degree relative (such as a parent or sibling) with the disease. This is because genetic factors can affect the body’s ability to produce or effectively use insulin, leading to high blood sugar levels.

Viral Causes

Some viral infections, such as rubella, can increase the risk of developing diabetes. This is because these infections can damage the cells in the pancreas that produce insulin, leading to insulin deficiency and high blood sugar levels.

Pollution

Exposure to certain environmental pollutants, such as pesticides and heavy metals, has been linked to an increased risk of developing diabetes. This is because these pollutants can disrupt the body’s hormone system and metabolism, leading to insulin resistance and high blood sugar levels.

Air pollution can cause type II diabetes through several mechanisms. Firstly, air pollution is associated with the development of insulin resistance, a key factor in the development of type II diabetes. Fine particulate matter (PM2.5) and other pollutants can induce systemic inflammation and oxidative stress, which can impair insulin signaling and lead to insulin resistance. Additionally, air pollution has been linked to the dysfunction of pancreatic beta cells, which are responsible for producing insulin. Exposure to air pollutants such as nitrogen dioxide and ozone has been shown to negatively impact beta cell function, contributing to the development of type II diabetes. Furthermore, air pollution is associated with an increased risk of obesity, another major risk factor for type II diabetes. Studies have demonstrated that exposure to air pollutants can disrupt metabolic processes and promote weight gain, further increasing the risk of developing type II diabetes. Overall, the evidence suggests that air pollution can contribute to the development of type II diabetes through its effects on insulin resistance, beta cell function, and obesity.

Heavy Metals

Exposure to heavy metals, such as lead and mercury, can also increase the risk of developing diabetes. This is because these metals can damage the cells in the pancreas and disrupt the body’s hormone system.

Inflammation

Chronic inflammation can contribute to the development of insulin resistance and high blood sugar levels, which are hallmarks of diabetes. This is because inflammation can damage the cells in the pancreas and disrupt the body’s hormone system.

Autoimmune Causes

In some cases, diabetes can be caused by an autoimmune response, in which the body’s immune system mistakenly attacks and destroys the cells in the pancreas that produce insulin. This can lead to insulin deficiency and high blood sugar levels.

Infectious Causes

Certain infections, such as streptococcus, can trigger the development of diabetes in some individuals. This is because these infections can damage the cells in the pancreas and disrupt the body’s hormone system.

Toxic Causes

Exposure to certain toxic substances, such as certain medications and chemicals, can increase the risk of developing diabetes. This is because these substances can disrupt the body’s hormone system and metabolism, leading to insulin resistance and high blood sugar levels.

Acquired Causes

Finally, diabetes can be acquired through certain medical conditions, such as pancreatitis and pancreatic cancer, which can damage the pancreas and disrupt insulin production.

In conclusion, diabetes can have a variety of causes, and it is essential to understand these causes to effectively manage and prevent the condition. By being aware of these causes, individuals can take steps to reduce their risk of developing diabetes and manage the condition if it does occur.

Diet and Nutrition

Individuals with type II diabetes often face various nutritional issues and deficiencies, impacting both macronutrients and micronutrients. These deficiencies can exacerbate the complications associated with diabetes and may include:

Macronutrition:

  1. Carbohydrates: People with type II diabetes often struggle to manage their blood sugar levels, leading to challenges in carbohydrate metabolism. This can result in fluctuations in blood glucose levels, making it essential for individuals to monitor their carbohydrate intake carefully.
  2. Proteins: While protein intake is generally not a major concern for individuals with type II diabetes, it is important to consume lean sources of protein to support muscle health and overall well-being.
  3. Fats: Managing fat intake is crucial for those with type II diabetes, as excessive consumption of saturated and trans fats can contribute to cardiovascular complications, which are already a significant risk for individuals with diabetes.Micronutrition:
  1. Vitamins: Deficiencies in certain vitamins, particularly vitamin D and B vitamins (such as B12 and folate), are common among individuals with type II diabetes. Vitamin D deficiency has been linked to insulin resistance, while B vitamin deficiencies can impact nerve function and contribute to diabetic neuropathy.
  2. Minerals: Key minerals such as magnesium, potassium, and chromium are often deficient in individuals with type II diabetes. Magnesium deficiency can exacerbate insulin resistance, while potassium plays a role in blood pressure regulation. Chromium is involved in glucose metabolism and may help improve insulin sensitivity.

Diabetes is a complex and multifactorial disease that can be caused by a variety of factors, including genetic predisposition, viral infections, environmental pollution, exposure to heavy metals, chronic inflammation, autoimmune reactions, infectious diseases, and acquired conditions. Genetic factors play a significant role in the development of diabetes. Individuals with a family history of diabetes are at a higher risk of developing the condition. Specific genes related to insulin production, insulin action, and glucose metabolism have been identified as contributing to the risk of diabetes.

Viral infections have also been linked to the development of diabetes. Certain viruses, such as enteroviruses and cytomegalovirus, have been associated with an increased risk of developing type 1 diabetes. These viruses can trigger an autoimmune response that leads to the destruction of insulin-producing beta cells in the pancreas.

Environmental pollution and exposure to heavy metals have been suggested as potential risk factors for diabetes. Studies have indicated that air pollution and exposure to heavy metals such as arsenic, cadmium, and lead may contribute to the development of insulin resistance and impaired glucose metabolism.

Chronic inflammation is another important factor in the pathogenesis of diabetes. Inflammatory processes can disrupt normal insulin signaling and contribute to insulin resistance. Conditions such as obesity, which is characterized by chronic low-grade inflammation, are closely linked to the development of type 2 diabetes.

Furthermore, autoimmune reactions can lead to the destruction of pancreatic beta cells, resulting in type 1 diabetes. The immune system mistakenly attacks and destroys these cells, leading to a deficiency in insulin production.

Infectious diseases such as congenital rubella syndrome and cytomegalovirus infection have been associated with an increased risk of diabetes due to their impact on pancreatic function and insulin production.

Additionally, certain toxic substances, including chemicals and medications, can contribute to the development of diabetes. Exposure to toxins such as bisphenol A (BPA), phthalates, and some medications has been linked to an elevated risk of developing diabetes.

Nutrition plays an essential role in both the prevention and management of diabetes. A balanced diet that includes essential nutrients such as fatty acids, vitamins (including vitamin D, vitamin C, and B12), magnesium, protein, carbohydrates, healthy fats, and low-inflammatory foods is crucial for maintaining optimal metabolic function and managing blood sugar levels.

First, it’s important to note that while herbs can be a helpful complement to traditional medical treatment for diabetes, they should not be used as a replacement for medical advice or treatment. It’s always best to consult with a qualified healthcare professional before starting any new herbal supplements or making significant changes to your diet or exercise routine.

That being said, here are the top 10 herbs commonly used to help manage diabetes type 2, along with their recommended dosages and food courses:

  1. Gymnema sylvestre: This herb has been shown to help regulate blood sugar levels and improve insulin sensitivity. Recommended dosage: 400-500 mg per day, in divided doses before meals. Food course: As a tea or capsule.
  2. Cinnamon: Cinnamon has been found to improve insulin sensitivity and reduce blood sugar levels. Recommended dosage: 1-6 grams per day, in divided doses before meals. Food course: As a spice in cooking or as a supplement in capsule form.
  3. Bitter melon: Bitter melon has been traditionally used in Ayurvedic medicine to help manage blood sugar levels. Recommended dosage: 500-600 mg per day, in divided doses before meals. Food course: As a capsule or juice.
  4. Ginkgo biloba: Ginkgo biloba has been found to improve insulin sensitivity and reduce inflammation. Recommended dosage: 80-240 mg per day, in divided doses before meals. Food course: As a capsule or tea.
  5. Turmeric: Turmeric contains curcumin, which has anti-inflammatory and antioxidant properties that may help improve insulin sensitivity. Recommended dosage: 500-2000 mg per day, in divided doses before meals. Food course: As a spice in cooking or as a supplement in capsule form.
  6. Fenugreek: Fenugreek has been found to improve insulin sensitivity and reduce blood sugar levels. Recommended dosage: 500-1000 mg per day, in divided doses before meals. Food course: As a capsule or tea.
  7. Cayenne pepper: Cayenne pepper contains capsaicin, which may help improve insulin sensitivity and reduce inflammation. Recommended dosage: 100-200 mg per day, in divided doses before meals. Food course: As a spice in cooking or as a supplement in capsule form.
  8. Banaba leaf: Banaba leaf has been traditionally used in Ayurvedic medicine to help manage blood sugar levels. Recommended dosage: 100-200 mg per day, in divided doses before meals. Food course: As a capsule or tea.
  9. Glucomannan: Glucomannan is a type of fiber that may help slow the absorption of sugar into the bloodstream. Recommended dosage: 500-1000 mg per day, in divided doses before meals. Food course: As a capsule or powder mixed with water.
  10. Beta-glucans: Beta-glucans are a type of fiber that may help stimulate the immune system and improve insulin sensitivity. Recommended dosage: 500-1000 mg per day, in divided doses before meals. Food course: As a capsule or powder mixed with water.

Hormonal Influences 

DHEA (dehydroepiandrosterone) is a steroid hormone produced by the adrenal glands and plays a role in regulating metabolism, immune function, and the body’s response to stress. Research has suggested that DHEA may have potential benefits for individuals with type II diabetes. Some studies have indicated that DHEA supplementation could improve insulin sensitivity and glucose metabolism in individuals with type II diabetes. Additionally, DHEA has been linked to improvements in lipid profiles and body composition, which are important factors in managing type II diabetes.

Pregnenolone is a precursor hormone that serves as a building block for the production of other steroid hormones, including DHEA and testosterone. While there is limited direct research on pregnenolone’s specific role in type II diabetes, its relationship to other hormones involved in metabolic regulation suggests potential relevance. Pregnenolone’s influence on hormone balance and its impact on stress response may indirectly affect metabolic processes relevant to type II diabetes.

Testosterone is a key hormone that plays a significant role in metabolic regulation, body composition, and insulin sensitivity. Low testosterone levels have been associated with an increased risk of developing type II diabetes and may contribute to the progression of the condition. Testosterone replacement therapy has been studied as a potential intervention for improving insulin sensitivity and glycemic control in men with type II diabetes. However, the use of testosterone therapy in individuals with type II diabetes remains a topic of ongoing research and debate due to potential risks and uncertainties regarding long-term effects.

Top 10 Vitamins and Minerals for Diabetes Type II:

  1. Vitamin D: Vitamin D is essential for maintaining healthy blood sugar levels and insulin sensitivity. The recommended dosage for vitamin D is 1,000-2,000 IU (International Units) per day. Food sources include fatty fish, fortified dairy products, and mushrooms.
  2. Vitamin B12: Vitamin B12 plays a crucial role in the metabolism of carbohydrates, fats, and proteins. The recommended dosage for vitamin B12 is 2.4-2.6 mcg (micrograms) per day. Food sources include animal products such as meat, poultry, fish, and dairy products.
  3. Vitamin B6: Vitamin B6 helps regulate blood sugar levels and insulin secretion. The recommended dosage for vitamin B6 is 1.3-1.5 mg (milligrams) per day. Food sources include bananas, potatoes, chicken, and fish.
  4. Vitamin E: Vitamin E is an antioxidant that helps protect cells from damage and supports insulin sensitivity. The recommended dosage for vitamin E is 400-800 IU (International Units) per day. Food sources include nuts, seeds, and vegetable oils.
  5. Magnesium: Magnesium is essential for carbohydrate metabolism and insulin function. The recommended dosage for magnesium is 300-400 mg (milligrams) per day. Food sources include dark leafy greens, nuts, and whole grains.
  6. Chromium: Chromium is a mineral that helps regulate blood sugar levels and insulin sensitivity. The recommended dosage for chromium is 200-400 mcg (micrograms) per day. Food sources include whole grains, broccoli, and apples.
  7. Zinc: Zinc is essential for insulin function and glucose metabolism. The recommended dosage for zinc is 15-30 mg (milligrams) per day. Food sources include oysters, beef, chicken, and fortified cereals.
  8. Copper: Copper is an essential mineral that helps regulate blood sugar levels and insulin sensitivity. The recommended dosage for copper is 1.5-3 mg (milligrams) per day. Food sources include shellfish, nuts, and legumes.
  9. Manganese: Manganese is involved in the metabolism of carbohydrates, fats, and proteins. The recommended dosage for manganese is 2.3-2.8 mg (milligrams) per day. Food sources include spinach, legumes, and whole grains.
  10. Selenium: Selenium is an antioxidant that helps protect cells from damage and supports insulin sensitivity. The recommended dosage for selenium is 50-70 mcg (micrograms) per day. Food sources include Brazil nuts, fish, and turkey.

Fatty acids, particularly omega-3 fatty acids found in fish oil, have been shown to have beneficial effects on insulin sensitivity and inflammation. They may help reduce the risk of developing type 2 diabetes.

Vitamin D is involved in insulin secretion and sensitivity. Adequate levels of vitamin D are associated with a lower risk of developing type 2 diabetes.

Vitamin C is an antioxidant that may help reduce oxidative stress and inflammation associated with diabetes.

Vitamin B12 plays a role in nerve function and red blood cell production. Deficiency in vitamin B12 can lead to neuropathy and other complications related to diabetes.

Magnesium is involved in glucose metabolism and insulin action. Low magnesium levels have been linked to an increased risk of type 2 diabetes.

Adequate intake of protein, from both animal and plant sources, is important for maintaining muscle mass and overall metabolic health.

A high protein diet can play a significant role in managing diabetes type II and its associated health issues. Protein is an essential macronutrient that is crucial for various bodily functions, and its impact on diabetes management extends to several aspects including renal health, lean body mass, inflammation, blood sugar regulation, heart disease risk, immunity, optic and neuropathy health, as well as oxidative stress.

Renal Health: Individuals with diabetes type II are at a higher risk of developing kidney disease. Protein plays a crucial role in maintaining renal health by supporting the structure and function of the kidneys. However, it is important to note that excessive protein intake may potentially strain the kidneys in individuals with existing kidney disease. Therefore, moderation and individualized recommendations are key.

Lean Body Mass: Protein is essential for the maintenance and growth of lean body mass. In individuals with diabetes type II, preserving muscle mass is particularly important as it can contribute to improved insulin sensitivity and glucose metabolism.

Inflammation: Chronic low-grade inflammation is often associated with diabetes type II. High protein diets have been shown to have anti-inflammatory effects, which can be beneficial for individuals with diabetes in managing inflammation-related complications.

Blood Sugar Regulation: Protein has minimal impact on blood sugar levels compared to carbohydrates. Including adequate protein in the diet can help stabilize blood sugar levels and reduce the risk of sudden spikes or crashes, contributing to better glycemic control in individuals with diabetes type II.

Heart Disease Risk: Diabetes type II increases the risk of cardiovascular diseases. A high protein diet, especially when the protein sources are lean and healthy (such as fish, poultry, legumes, and nuts), can have a positive impact on lipid profiles and overall heart health.

Immunity: Proteins are essential for the production of antibodies and immune system function. Adequate protein intake supports immune function, which is important for individuals with diabetes who may be more susceptible to infections.

Optic and Neuropathy Health: Diabetes can lead to complications such as diabetic retinopathy (affecting vision) and neuropathy (nerve damage). Protein plays a role in maintaining the health of these tissues and may contribute to reducing the risk or progression of these complications.

Oxidative Stress: Diabetes type II is associated with increased oxidative stress due to elevated levels of free radicals. Protein contains amino acids that serve as precursors for antioxidants, which can help combat oxidative stress and reduce cellular damage.

In conclusion, a high protein diet can be beneficial for individuals with diabetes type II in various ways including supporting renal health (with caution), preserving lean body mass, managing inflammation, regulating blood sugar levels, reducing heart disease risk, supporting immunity, maintaining optic and neuropathy health, and combating oxidative stress.

Balancing intake of carbohydrates, focusing on complex carbohydrates with a low glycemic index, can help manage blood sugar levels more effectively.

Consumption of healthy fats, such as those found in avocados, nuts, seeds, and olive oil, can support cardiovascular health and improve insulin sensitivity.

Incorporating a variety of phytonutrients from fruits, vegetables, herbs, spices, and teas into the diet can provide antioxidants and anti-inflammatory compounds that support overall health and may help reduce the risk of developing diabetes.

Hormonal balance is also crucial for metabolic health. Proper regulation of hormones such as insulin, glucagon, cortisol, thyroid hormones, and sex hormones is essential for maintaining optimal blood sugar control.

Herbal supplements such as cinnamon, bitter melon extract, fenugreek seeds, berberine, and others have been studied for their potential benefits in supporting glucose metabolism and insulin sensitivity.

In summary,genetic predisposition, viral infections,environmental pollution, exposure to heavy metals,chronic inflammation, autoimmune reactions,infectious diseases, toxic substances are all potential causes or contributing factors to the development of diabetes. Nutrition plays a critical role in both preventing and managing diabetes through its impact on various aspects of metabolic health including fatty acids,vitamins (including vitamin D,vitamin C,B12),magnesium ,protein ,carbohydrates ,healthy fats ,low inflammation,hormonal balance ,herbal supplements,and phytonutrients

Lab Tests

  1. Bone Density Testing: This test measures the density of your bones using X-rays or other imaging technologies. It is used to assess the risk of osteoporosis and fractures, which are common complications of diabetes.
  2. Peripheral Blood Smear: A peripheral blood smear is a test that examines a sample of your blood to look for abnormalities in the shape and size of your red and white blood cells. It can help diagnose anemia, infection, and other conditions that may be related to diabetes.
  3. EKG (Electrocardiogram): An EKG is a test that measures the electrical activity of your heart. It is used to diagnose heart problems, such as arrhythmias and cardiac ischemia, which can be more common in people with diabetes.
  4. Arterial Stiffness Testing: This test measures the flexibility of your arteries, which can become stiffer and less flexible due to diabetes. It can help diagnose conditions such as atherosclerosis and predict the risk of heart disease.
  5. HgA1C Test: This test measures your average blood sugar levels over the past 2-3 months. It is used to diagnose and monitor diabetes, and to determine the effectiveness of diabetes treatment plans.
  6. Serum Glucose Test: This test measures your blood sugar levels at a specific point in time. It is used to diagnose and monitor diabetes, and to evaluate how well your diabetes treatment plan is working.
  7. Triglycerides Test: This test measures the amount of triglycerides in your blood. Triglycerides are a type of fat found in your blood that can increase your risk of heart disease.
  8. C-Peptide Test: This test measures the amount of C-peptide, a protein produced by your pancreas, in your blood. It can help diagnose and monitor diabetes, and to determine the effectiveness of diabetes treatment plans.
  9. Cholesterol Test: This test measures the level of cholesterol in your blood. High cholesterol can increase your risk of heart disease, which is a common complication of diabetes.
  10. Homocysteine Test: This test measures the level of homocysteine, an amino acid found in your blood. Elevated homocysteine levels can increase your risk of heart disease and stroke.
  11. Testosterone Test: This test measures the level of testosterone in your blood. Low testosterone levels can be a sign of hypogonadism, a condition that can be associated with diabetes.
  12. Vitamin/mineral testing
  13. Autonomic Nervous System Testing

Blood Detective Evaluation

The Blood Detective approach is particularly beneficial for assessing the health and nutritional needs of individuals with type II diabetes because it focuses on comparing diabetics to healthy individuals rather than just average people. This approach involves evaluating clinical blood ranges versus functional/healthy ranges, which can help identify potential health issues earlier than traditional clinical or average ranges on blood test results.

When comparing diabetics to healthy individuals, it becomes evident that the standard clinical blood ranges may not accurately reflect the optimal health markers for those with type II diabetes. By using functional/healthy ranges as a benchmark, healthcare professionals can gain a more comprehensive understanding of the specific nutritional and health needs of individuals with type II diabetes.

The Blood Detective approach is effective for assessing the health and nutritional needs of those with type II diabetes because it allows for a more tailored and precise evaluation of their blood test results. By comparing diabetics to healthy individuals, rather than just average people, this approach can uncover potential health issues at an earlier stage by utilizing functional/healthy ranges as a reference point.

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*DISCLAIMER: Dr. Michael Wald is a doctor of chiropractic with a masters degree in nutrition. He is also a Certified Dietitian Nutritionist and a Certified Nutritional Specialist and Sports Nutritionist. Dr. Wald is certified to provide acupuncture in several states, but not New York. Dr. Wald has two board certifications in nutrition. Dr. Michael Wald earned his MD diploma, but did not complete a residency and is thus not licensed to practice medicine. The information on this site is intended for educational purposes only and is not to substitute for sound medical or health advice. Information contained within this website may change at any time without prior notice. The information on this website is under copyright, 2021.