Diabetes: Holistic Treatment of Type II Diabetes
Diabetes is often misunderstood as a simple sugar imbalance that can be readily corrected through medical intervention. In reality, it is a complex metabolic disorder that includes not just elevated sugar but significant nutrient deficiencies, abnormal metabolism, and even changes in genetic expression.
The disease has serious implications for cardiovascular health, kidney health, neural function, and vision. Clinicians and researchers specializing in type II diabetes (the predominant form by far) believe there is a strong correlation with obesity, physical inactivity, family history and ethnicity.
The World Health Organization (WHO estimates that by 2025 the number of people with diabetes worldwide will reach 300 million – a staggering 122% increase in less than 30 years.
Currently, it is estimated that over six percent of the U.S. population are diabetic. Ninety percent have type II diabetes (also called non-insulin-dependent diabetes). It is believed that many more Americans have this disease but are unaware that they do.
Diabetes is now recognized as the sixth leading cause of death and disability in the U.S. Its associated health-care costs have more than doubled between 1997 and 2002, from $44 billion to $92 billion.
Diabetes in Children
Virtually unknown in children until recent years, type II diabetes is now appearing with alarming regularity in overweight and sedentary preteens and adolescents. During the last three decades, the number of overweight Americans in these age groups has more than doubled, and the dramatic rise in the incidence of type II diabetes in these groups directly correlates with the rising rate of obesity in American children, a quarter of whom are overweight nowadays.
Some 85% of American children who have developed type II diabetes are overweight at the time of diagnosis. The percentage of children with newly diagnosed type II diabetes has ballooned from less than five percent in 1994 to an estimated 30 to 50 percent a decade later.
Dr. Arlen Rosenblum, chair of the American Diabetes Association’s Consensus panel, puts this situation bluntly, warning that type II diabetes in children is an emerging epidemic.
In most cases, the underlying cause of type II diabetes is insulin resistance. Insulin resistance, which can begin years before diabetes itself, is a fundamental factor in a number of medical conditions, including obesity, hypertension (high blood pressure), abnormalities in cholesterol and triglyceride levels, and increased risk of heart disease.
Approximately 60 million Americans have insulin resistance (often considered pre-diabetes), much more than have diabetes itself. Many of them don’t realize that they have this condition, and that undiagnosed, left uncontrolled it can lead to diabetes or diseases associated with the complications of diabetes. (A third to a half of those diagnosed with insulin resistance will progress to diabetes, and of these two-thirds will die of cardiovascular complications.)
For most type II diabetics, the pancreas (a gland behind the stomach) secretes plenty of insulin, more than enough to escort glucose into the cells. (A hormone, insulin is produced by specialized beta cells in the pancreas and secreted into the blood in response to elevated blood-sugar levels.) The problem in insulin resistance is a growing desensitization to the efforts of insulin to escort glucose into the cells. (The glucose molecule is too large to pass through the surface of cells by itself.)
Recent research suggests that the root cause of insulin resistance is a breakdown in intercellular signaling. Insulin serves as a chemical messenger, signaling proteins called GLUT-4 transporters, which reside within the cell, to rise to the cell membrane (surface) where they grab onto glucose and take it inside the cell.
Once inside, the cell utilizes glucose as fuel. The cell stores excess glucose as glycogen (a form of animal starch) or converts it to glycerol for the formation of fat. In stressful times or when blood sugar levels are low, the pancreas and liver perform a balancing act crucial for regulation of the body’s blood-sugar level.
By the action of glucagon (another pancreatic hormone), the liver converts its reserves of glycogen back to glucose. Glucagon also stimulates the breakdown of fat in adipose tissue to glycerol and fatty acids. The liver then reconverts glycerol and fatty acids to glucose, releasing it into the blood.
As insulin resistance increases, it disrupts this balancing act. Normal levels of insulin no longer easily beckon the GLUT-4 transporters. The pancreatic beta cells start to pump out ever-rising amounts of insulin. But chronically high levels of insulin then desensitize the cellular receptors, resulting in greater insulin resistance. This damaging cycle eventually leads to type II diabetes.
Insulin resistance is a predictor of heart disease. It causes increased levels of low density lipoproteins (LDL), “bad” cholesterol. It can raise hypertension and weight gain.
According to various studies, insulin resistance may account for a large percentage of heart attacks. Half of patients with high blood pressure have insulin resistance.
As noted earlier, insulin resistance is closely related to obesity. Insulin signals the liver to produce more very low density lipoprotein (VLDL). VLDL acts as a carrier of triglycerides and fats in blood. The higher the level of VLDL and triglycerides, the more fat is circulating in the blood.
Some VLDL is converted to LDL cholesterol, but particularly the smaller, more atherogenic LDL particles. Also, high levels of VLDL can lead to a lowering of the protective type of cholesterol carriers called high density lipoproteins (HDL).
High levels of insulin also acutely raise the levels of fibrinogen, a substance that encourages formation of blood clots, and thus may contribute to heart attacks. Insulin raises, too, the levels of plasminogen activator inhibitor – PAI-1 – which slows down the breakup of these blood clots.
Finally, high levels of insulin increase levels of C-reactive protein, an inflammatory agent whose major source is abdominal fat. C-reactive protein is implicated in the development of central body obesity and the onset of type II diabetes. It raises the risk of cardiovascular disease.
Diagnosing Type II Diabetes
Based upon a recommendation by the Expert Committee on the Diagnosis and Classification of Diabetes, a threshold for diagnosing diabetes was established in 1997. It held that fasting blood glucose levels higher than 126 on two separate occasions classified a person as a diabetic.
The glucose tolerance test offers a second way to diagnose diabetes. The WHO recommends that both the fasting glucose test and the glucose tolerance test both be used as screening tools in diagnosing diabetes.
The rationale for the WHO recommendation is that the fasting glucose test will miss many people who may not have frank diabetes but do have impaired glucose tolerance or insulin resistance (pre-diabetes). Only through the glucose tolerance test, especially if it is done with measuring insulin levels, can one identify pre-diabetic conditions.
The Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) is a comprehensive trial that involved more than 25,000 patients followed for an average of 7.3 years. The DECODE researchers confirmed that fasting glucose concentrations alone do not identify individuals at increased risk of death associated with hyperglycemia. The oral glucose tolerance test, they said, provides additional prognostic information and enables detection of individuals with impaired glucose tolerance who have the greatest attributable risk of death.
Insulin Resistance and Type II Diabetes: Part of a Spectrum
Identifying and treating patients well on the way to developing frank diabetes is extremely important. Insulin resistance, for instance, begins taking a toll on the body, especially the cardiovascular system, long before the damage becomes clinically evident.
Many experts believe that the destructive mechanisms associated with insulin resistance are at work up to 15 years prior to diagnosis. Meanwhile, the risk of heart disease and other complications are growing behind one’s back.
The DECODE finding suggest that by the time a patient is diagnosed with type II diabetes, damage to the cardiovascular system is well under way.
Vitamin and Mineral Deficiencies Associated with Diabetes
Vitamin and mineral deficiencies are quite common in diabetics. An article published in the American Journal of Clinical Nutrition, reviewing 247 studies, found that type I diabetics generally have deficiencies in zinc, calcium, magnesium, and vitamin D. Many are also low in vitamins B6 and B12. (Type I diabetes, called insulin-dependent diabetes, accounts for ten percent of all cases of this disease.)
The review article also found that individuals with type II diabetes tend to be very low in zinc, magnesium, vitamin C, and vitamins B6 and B12.
This section of my article on type II diabetes looks at the more important deficiencies in diabetics and at certain natural substances important in prevention and/or treatment of this complex condition.
VANADIUM Research suggests that vanadium acts in a manner very similar to insulin. The primary activity of insulin in blood glucose metabolism is to stimulate the GLUT-4 transporters to rise to the surface of the cell, latch onto glucose, and carry it inside. Vanadium has been identified as one of the few compounds other than insulin that can activate these GLUT-4 transporters.
In a 1996 study, eight men and women with type II diabetes received 50mgs of vanadyl sulfate twice a day for four weeks, followed by placebo for four weeks. A 20% average reduction in fasting glucose was noticed, which extended into the placebo period.
CHROMIUM Named the glucose tolerance factor, chromium is a very important natural compound for diabetes. It improves insulin activity and facilitates the uptake of glucose into cells. Many well controlled studies have indicated that chromium supplementation in diabetes can be very helpful in improving glucose metabolism.
In a study jointly conducted by the Human Nutrition Research Center of the U.S. Dept. of Agriculture and the Beijing Medical University (China), investigators divided 180 diabetics into three groups and assigned each group a specific protocol. Group 1 received 100mcgs of chromium picolinate twice a day. Group 2 received 500mcgs. Group 3 got only placebo. When their blood sugar levels were tested after four months, patients taking chromium supplements had reductions in blood sugar, insulin, cholesterol, and hemoglobin A1c (glycosylated hemoglobin, increased levels of which correlate with glucose intolerance). Those taking 500mcgs daily generally had greater reductions than those on lower doses.
Chromium can also be beneficial in weight loss. In a study published in 1998, 122 subjects were given either 400mcgs of chromium picolinate daily or placebo. After 90 days, it was determined that chromium supplementation had positive effects on weight and body composition. Those on chromium lost more weight than those on placebo.
In the U.S., chromium deficiency is common, quite possibly because high consumption of sugar and refined grains depletes chromium reserves in the body. Chromium concentrations in the tissues of Americans declines with age, and this decline may be why the incidence of type II diabetes increases in older Americans..
MAGNESIUM Deficiencies in magnesium are linked to heart disease. This mineral plays a vital role in cardiovascular function. It relaxes the muscles of the arteries, improves blood flow, lowers blood pressure, and reduces the likelihood of arterial spasms that can contribute to heart attacks.
The medical literature includes numerous studies demonstrating that diabetics have below average blood levels of magnesium, and certainly intracellular magnesium deficiencies.
Magnesium has a fundamental role in carbohydrate metabolism in general and a very specific role in the action of insulin, so low levels of magnesium may contribute to poor control of diabetes. Magnesium is also associated with diabetic retinopathy. In a study by P. McNair, MD, titled “Hypomagnesemia, a Risk Factor in Diabetic Retinopathy, McNair showed that diabetics with the lowest magnesium levels had the most severe retinopathy.
Like other essential minerals and trace elements, magnesium can easily be lost in diabetics in the urine.
VITAMIN C A potent antioxidant believed to buttress the body’s immune system, vitamin C lessens inflammation associated with diabetes (by reducing the level of C-reactive protein). It also lowers the risk of cardiovascular complications. Deficiency in this vitamin can result in capillary fragility and delayed wound healing.
In a major study reported in the early 1990s, researchers examined the effects of vitamin C on the heart and vascular system. They analyzed the vitamin C intake of 11,348 adults over a period of five years and found that men with the highest intakes of this vitamin – more than 300mgs daily from both food and supplements – had a 45% lower risk of death from cardiovascular disease than men with the lowest intakes – less than 50mgs daily. (Engstrom JE et al, Vitamin C intake and mortality among a sample of the U.S. population, Epidemiology, 3:194-202, 1992.)
High intake of vitamin C lowers blood glucose and protects against other harmful processes that occur in diabetes. For instance, vitamin C inhibits glycosylation of proteins, a process in which glucose attaches to proteins and distorts the molecular geometric configuration of the proteins, resulting in dysfunction of these proteins and ultimately cellular dysfunction.
The accumulation of sorbitol (also known as glucytol, a sugar alcohol the body metabolizes slowly), which can lead to cataracts, is reduced by vitamin C. A 1994 study followed young adults [number?]with insulin-dependent diabetes (type I). According to food diaries these diabetics kept, they had been getting the required daily allowance (RDA) of vitamin C. The investigators first measured the amount of sorbitol in the patients’ red blood cells and determined that it averaged twice the normal level. The patients were then given either 400mgs or 600mgs of supplemental C daily for 58 days. When the investigators repeated the measurement of sorbitol in the red blood cells, the concentration of sorbitol had normalized after just 30 days of supplementation. (Cunningham JJ et al, An aldose reductase inhibitor that normalizes erythrocyte sorbitol in insulin-dependent diabetes mellitis, J. American College of Nutrition, 4:334-350, 1994).
Because vitamin C, which helps replenish and synergize other antioxidants, is the main antagonist for the excessive free radical activity observed in diabetes, adequate amounts are necessary for diabetics. But most diabetics are deficient in vitamin C.
VITAMIN E Another powerful antioxidant, vitamin E has been shown in a preponderance of well conducted trials to protect against cardiovascular disease. In diabetes, vitamin E increases insulin sensitivity, enhances lipid transport, and helps inhibit glycosylation of proteins. Research indicates, too, that vitamin E reduces vascular inflammation and lowers levels of C-reactive protein (in doses as high as 1200mgs daily).
Vitamin E’s effects in protecting against heart disease were impressively demonstrated in 1996 in a double blind, placebo controlled study called the Cambridge Heart Antioxidant Study (CHOAS). CHAOS involved 2,002 patients divided into two groups. One group took 400 to 800 international units of vitamin E. The other group received placebo. After an average period of 510 days, the group on vitamin E had 75% fewer heart attacks than those on placebo.
A study published in Circulation in 2000 investigated the effects of vitamin E on 50 subjects with type II diabeties. Half the study subjects had vascular complications, the other half had cardiovascular disease. The investigators showed that even in the diabetics with no signs of cardiovascular disease there was evidence of accelerated free radical activity as well as inflammation. When the investigators gave the study subjects high dose vitamin E (1200 international units), free radical activity fell and there was a clear reduction in inflammatory markers.
Other studies have suggested that high dose vitamin E supplementation may even act to prevent the metabolic syndrome that leads to diabetes.
LIPOIC ACID Also known as Alpha-lipoic acid, lipoic acid is a small sulfur-containing compound essential for important energy-producing reactions in the body. In addition, lipoic acid is a strong antioxidant, which is both water and fat soluble. In diabetes, it’s been shown to boost glucose disposal and improve insulin sensitivity. It does the latter by increasing the activity of the GLUT-4 transporters (the proteins that rise to the surface of the the cells to usher glucose in).
In a 1999 placebo controlled study involving 72 subjects with type II diabetes, the researchers gave oral supplements of lipoic acid in doses of 600, 1200, and 1800mgs daily for four weeks. Another group received placebo. Glucose uptake by cells increased by an average of 63% in the individuals taking lipoic acid – regardless of the dose – and the supplemental lipoic acid outperformed the placebo by 300%!
Lipoic acid also protects against diabetic complications, reduces the degree of glycosylation in tissues, improves circulation, and even stimulates regeneration of nerves.
More than 15 clinical trials have examined the effects of lipoic acid in diabetic neuropathy, indicating that it improves neuropathy. Most of these studies have utilized IV administration, which has proven much more effective than oral administration.
Vitamins, Minerals, Elements, and Other Natural Substances Useful in Treating Diabetes
Diets high in refined carbohydrates and foods rich in trans fats factor into the onset of pre-diabetes and diabetes. Generally speaking, refined carbohydrates produce insulin, and the more one consumes refined carbohydrates, the more one increases the production of insulin. White rice, white flour-based foods, pasta, starchy vegetables, and many processed foods quickly convert to blood sugar as they are digested; as a result, insulin levels spike. All these “carbs” are known as high-glycemic foods
Low-glycemic carbohydrates include asparagus, broccoli, cabbage, green beans, and other low-starch vegetables. These carbohydrates convert more slowly to blood sugar and raise blood insulin levels gradually.
Trans fats, the hydrogenated or partly hydrogenated oils abundant in fast and processed foods, greatly increase the risk of diabetes. Substituting polyunsaturated fats for trans fats is essential in prevention and treatment of pre-diabetes and diabetes. Foods containing “good” dietary fats include almond butter, almond oil, avocados, fish oil, nuts, olive oil, and oils obtained from flax, pumpkin, sesame, and sunflower seeds.
A high-fiber diet is also beneficial in preventing and treating diabetes. Insoluble and soluble fibers slow the passage of food through the stomach and intestines, which in turn slows the breakdown of high-glycemic foods, delaying glucose uptake into the blood. A study published in the New England Journal of Medicine in 2000 found that a diet high in fiber improves glycemic control, reduces insulin levels, and cuts concentrations of plasma lipids in less than two months.
Exercise is another life-style factor vital in prevention and management of diabetes. Regular exercise helps the body metabolize glucose. Weight loss through exercise, combined with a diet that lowers the risk of diabetes, normalizes insulin resistance levels. (Physically fit individuals also appear to secrete less insulin.) Some diabetes specialists believe that the combination of exercise and proper diet is the most effective way to treat insulin resistance and lower the risk of diabetes.
Substances useful in Treating Insulin Resistance
I noted in the very first paragraph of this article that diabetics (and pre-diabetics) show significant nutrient deficiencies. In addition to advising my patients on life style changes they need to make to prevent insulin resistance or diabetes from progressing, I recommend certain supplemental vitamins, minerals, and herbs.
For patients with insulin resistance, I give low dose diaxonol or a combination of chromium picolinate and gymnema silvestre. Diaxonol is a combination of gymnema silvestre, vanadyl sulfate, and lipoic acid, which helps maintain blood sugar levels within the normal range. Gymnema is a tropical forest vine native to India. It appears to increase the secretion of insulin from the pancreas and the uptake of carbohydrates by muscles.
For inflammation associated with insulin resistance, I recommend R-lipoic acid. Patients with insulin resistance also receive magnesium, curcumin, and sometimes bitter melon. Curcumin, the pigment that gives the spice turmeric its yellow color, has shown beneficial effects in insulin resistance and glucose tolerance in animal studies. (I use the kind with high bio-availability.) Bitter melon is a vegetable widely cultivated in Asia, Africa and South America. It has been used extensively in folk medicine as a remedy for diabetes. Recent experimental and clinical studies on extracts of the unripe vegetable and on fresh juice has demonstrated bitter melon’s blood sugar lowering action.
It’s important in detecting and treating insulin resistance to test patients for heavy metals and other toxins, and then, depending on what’s found, to chelate and/or detoxify.
Natural Substances Useful in the Treatment of Diabetes
Diabetics require a broad range of supplements. I recommend some of the B-complex vitamins, vitamin C (with bioflavonoids), vitamin D, and vitamin E (both alpha and gamma tocopherols) I give various minerals and trace elements: chromium picolinate, copper, magnesium, manganese, potassium, selenium, vanadium (vanadyl sulfate), and zinc.
Especially helpful herbs include: banaba leaf, gymnema silvestre, and Korean ginseng. Banaba leaf extract has been traditionally used in the Philippines to treat diabetes and kidney diseases. The leaves of this Southeast Asian tree appear to act in a similar manner to insulin by activating insulin receptors. Ginseng, commonly used in traditional Chinese medicine to treat diabetes, enhances the release of insulin from the pancreas and appears to increase the number of insulin receptors. It also has a direct blood sugar-lowering effect.
A mixture of herbs, Diatroxal, may assist with the regulation of blood sugar. There is some research that suggests it has this effect, so I add Diatroxal to the supplements I give diabetics. The herbal ingredients include: Garcinia Cambogia Extract, Gymnema Sylvestre Extract, Cinnamon Extract, Bitter Melon Extract, Betaine HCL, Banaba, Fenugreek, Vanadium, Chromium, Biotin USP, and Vitamin C. (Biotin and vitamin C, of course, are not herbs.)
In patients with diabetic neuropathy, I have good results with laser therapy and hyperbaric oxygen.