Disease, Illness and Condition Library
Diabetes
to affect 20 million Americans and countless others worldwide. There are two types of diabetes called appropriately diabetes 1 and diabetes 2. Of the types, diabetes Type 2 is the most common, accounting for up to 95 percent of all cases. Type 1 Diabetes – Accounting for about 5 percent of all cases. This type of diabetes occurs when the body immune system attacks the insulin producing cells in the pancreas and destroys them. Warning signs of type 1 diabetes: increased thirst, fatigue, blurred vision, weight loss, ravenous appetite, nausea, abdominal pain and frequent urination. Type 2 Diabetes – Accounting for up to 95 percent of all cases. The pancreas produces insulin but the body’s cells can’t successfully use it. Warning signs of type 2 diabetes: abnormal thirst, frequent urination, blurred vision, frequent infections, slow healing of wound and skin sores. Diabetes is an endocrine system disorder of the pancreas. The pancreas is located just behind the stomach and its job is to control how your body uses sugar, fats, and protein consumed from foods. When the pancreas fails to function correctly diabetes or other pancreatic diseases will start to appear. Did you know your body is reliant on glucose? It is the body’s main source of fuel. For you car minded reader’s, diabetes is like having a full tank of high octane fuel in your tank but your fuel line is clogged, stopping the fuel from getting to the engine. When you have diabetes the amount of glucose in your blood is too high. While having the proper amount of glucose in your blood is very important having too much can and does cause serious problems. Diabetes affects the way your body uses food for energy and growth. Most of the food you consume is broken down into glucose, which is broken down and carried throughout the body for use by the cells. To get inside the cells, a hormone called insulin must be present. When a healthy person consumes food their pancreas springs into action producing just the right amount of insulin to allow glucose to enter their cells but for diabetics the pancreas doesn’t produce enough insulin or their cells fail to respond to the insulin produced. At this point glucose builds up and overflows into the urine. When urination occurs the body expels one of its main sources of energy. This is serious disease! Much like some cancers it can be a slow killer that can diminish one’s quality of life radically over a long period of time. Diabetes has been known to cause heart disease; stroke, amputations, blindness and kidney damage just to name a few. When left untreated it can cause a combination of the serious health problems above. If you feel you have this disease you should consult your doctor. Diabetes Warning Signs Reviewed No matter what type of diabetes you may have, there are two major concerns; control of blood glucose levels and prevention of complications. If you even have the smallest inclination that you are suffering with this disease don’t hesitate in seeking professional help. Warning Signs * Unexplained weight loss * A change in vision * Slow healing of wounds and bruises * Thirst accompanied by frequent urination * Obesity (more than 20 pounds overweight) * Fatigue, weakness, irritability, and nausea * Anxiety, sweating, and hunger 3 hours after a large meal * Dry itching skin, and frequent skin infections * Tingling of the hands, feet, and legs * Frequent gum, bladder, and yeast infections
* Eliminate all refined sugar and sugar products. No cheating please. * Worth repeating, eliminate all refined sugars! * Eliminate Alcohol * Avoid Caffeine * Consume complex carbohydrates such as vegetables and whole grains * Eat protein snacks in between meals * If you must eat sugar blend it with protein and fiber * Stop Smoking * Exercise daily, making a part of your everyday routine * Reduce stress * Treat injuries with care; if you are suffering with diabetes you will not heal as fast, so take this into account when treating injuries.
Suitable and successful treatment of the diabetic patient requires the careful incorporation of a wide range of therapies, and patients who are willing to significantly alter their diet and lifestyle. Diabetic individuals must be monitored carefully, especially if they are on insulin or have relatively uncontrolled diabetes. Careful attention to symptoms, home glucose monitoring, and other blood tests are crucial in monitoring the progress of the diabetic individual. It is important to recognize that, as the diabetic individual employs some of the suggestions described below, drug dosage will have to be changed. Diet Dietary revision and treatment is fundamental to the successful treatment of diabetes, whether it is Type 1 or Type 2. Since diabetics have a higher frequency of death from cardiovascular disease (60 to 70% compared to 20 to 25% in people without diabetes), most of the dietary recommendations given in our article on cholesterol are equally important here. As stated earlier, the incidence of diabetes is highly correlated with the fiber depleted, high refined carbohydrate diet of many countries. Reestablishing a traditional diet and lifestyle reverses the carbohydrate and lipid metabolism abnormalities linked with the “foods of commerce”, and eventually results in a low prevalence of diabetes. The epidemiological facts indicting the Western diet and lifestyle as the ultimate etiological factor in diabetes is overwhelming. While there are several commonly suggested diets in the management of diabetes, the best one is not the one promoted by the American Diabetes Association (ADA), but rather one popularized by James Anderson, M.D. The Anderson diet recommends a diet high in cereal grains, legumes, and root vegetables, and low in simple sugars and fats. It is called the “high complex carbohydrate, high fiber diet, or “HCF diet” for short. Clinical trials of dietary treatment with a “primitive” diet high in plant cell wall materials and complex carbohydrates, and low in fat and animal products, have consistently demonstrated superior therapeutic effects over oral hypoglycemic agents, insulin (when less than units per day), and other previously recommended dietary regimes (carbohydrate restriction, high protein, and the ADA diet). The ADA Diet
Dietetic Association is clearly inferior to the HCF and MHCF diets. Nonetheless, it is presented here for historical purposes. The ADA’s exchange system is a useful concept and, as the diet is in common use by the typical physician, familiarity is necessary. It offers some beneficial support to many, especially if supplemented with dietary fiber (guar gum at 15 to 30 g/day or pectin at 30 to 45 g/day). A resurgence of interest in diet therapy resulted from the Universal Group Diabetes Program (UGDP) report which, in 1970, cast grave doubt on the efficacy and safety of oral hypoglycemic drugs. Prior to the report, the ADA diet consisted of high protein, high cholesterol, and high fat foods. This diet obviously exacerbated the already atherosclerosis prone state of diabetes and contributed to greater insulin insensitivity. In 1971, a revised ADA diet was developed based on the exchange system, a very useful concept for diabetic diets. The Importance of Dietary Fiber Population studies, as well as clinical and experimental research, show diabetes to be one of the diseases most visibly related to inadequate dietary fiber intake. These results indicate that, while the intake of refined sugars should be curtailed, the intake of complex carbohydrate sources that are rich in fiber should be increased. The term “dietary fiber” refers to the components of the plant cell wall as well as the indigestible residues form plant foods. Different types of fibers possess different actions. The type of fiber that exerts the most beneficial effects on blood sugar control are the water soluble forms. Included in this class are hemicelluloses, mucilages, gums, and pectin substances. These types of fiber are capable of: slowing the absorption and digestion of carbohydrates, thus preventing rapid rises in blood sugar; increasing the sensitivity of tissues to insulin, thereby preventing the excessive secretion of insulin; and improving uptake of glucose by the liver and other tissues, thereby preventing a continual elevation of blood sugar level. Luckily, the majority of fiber in most plant cell walls is water soluble. Particularly good sources of water soluble fiber are legumes (beans), oat bran, nuts, seeds, psyllium seed husks, pears, apples, and most vegetables. The optimal diet for diabetes includes a large amount of plant foods to guarantee adequate levels of dietary fiber. A daily intake of 50 grams is a reasonable goal. Frequent consumption of legumes is particularly important since a high carbohydrate, legume rich, high fiber diet has been shown to improve all aspects of diabetic control. Fiber Supplementation verses a High Fiber Diet Supplementation with the plant fibers (guar gum at a dosage of 5 g/meal or/and pectin at 10 g/meal) has demonstrated a constructive impact on diabetic control. These fiber supplements are now being used, along with the standard ADA diet, by many experts in diabetes. For example, David Jenkins and colleagues developed a palatable crisp bread containing guar gum. When diabetic patients consumed between 14 and 26 grams of guar per day, they required less insulin and had better control of blood sugar levels. It is interesting to note that these beneficial effects are maximized in patients whose diet includes at least 40% complex carbohydrates. Despite these positive results, fiber supplemented diets are not as effective as the HCF diet and are reserved for the Type 2 patient who is unwilling to implement the more difficult dietary change and will settle for palliative results. The insulin dosages of diabetics on fiber supplemented diets can usually be reduced to 33% of those used on control (ADA) diets, while the HCF diet has led to discontinuation of insulin therapy in approximately 60% of NIDDM patients and appreciably reduces doses in the other 40%. The Glycemic Index The “Glycemic index” was developed by David Jenkins in 1981 to measure the rise of blood glucose after consuming a particular food. The standard value of 100 is based on the rise seen after the ingestion of glucose. The glycemic index ranges from about 20 for fructose and whole barely to about 98 for a baked potato. The insulin response to carbohydrate containing foods is similar to the rise in blood sugar. The glycemic index is used as a guideline for dietary recommendations for people with either diabetes or hypoglycemia. Basically, people with blood sugar problems are advised to avoid foods with high values and choose instead carbohydrate containing foods with lower values. However, the glycemic index, should not be the only dietary guideline. For example, while high fat foods like ice cream and sausage may have a low glycemic index, these are not good choices for people with hypoglycemia or diabetes because a diet high in fat has been shown to impair glucose uptake. Fruits and Fructose Many physicians have recommended that individuals with diabetes or hypoglycemia avoid fruits and fructose (the primary form of sugar found in fruits). However, recent research disputes the approach. Fructose does not cause a rapid rise in blood sugar levels. Because fructose must be changed to glucose in the liver in order to be utilized by the body, blood glucose levels do not rise as rapidly after fructose consumption compared to other simple sugars. While most diabetics and hypoglycemics cannot tolerate sucrose, most can tolerate moderate amounts of fruits and fructose without loss of blood sugar control. In fact, fructose and fruits are not only much better tolerated than white bread and other refined carbohydrates, they produce less spiky elevations in blood sugar levels compared to most sources of complex carbohydrates (starch). As a additional benefit, fructose has actually been shown to enhance the sensitivity to insulin by 34% when fed to non-insulin- dependent diabetics over a period of four weeks. Nutritional Supplements The treatment of diabetes requires nutritional supplementation, as diabetics have a greatly increased need for many nutrients. Supplying the diabetic with additional key nutrients has been shown to improve blood sugar control and to help prevent or improve many of the major complications of diabetes. As we proceed to the discussion of specific nutrients and their usefulness it is important to point out that supplements should be used as an all-inclusive approach in which diet is the primary focus. Good blood sugar control combined with nutritional supplementation will go a long way in helping avert many of the major complications of diabetes. Chromium: Clinical studies in diabetes has shown that supplementing the diet with chromium can reduce fasting blood glucose levels, improve glucose tolerance, lower insulin levels, and decrease total cholesterol and triglyceride levels, while increasing HDL cholesterol levels. Although some studies have not shown chromium to exert much effect in improving glucose tolerance in diabetes, there is no doubt that it is an important mineral in blood sugar metabolism. A recent large study clearly documented the benefit of chromium for NIDDM patients. In this study, 180 Type 2 diabetics were placed in one of three groups. The first group was a placebo group; the second group received 100 mcg of chromium as chromium picolinate two times per day; and the third group received 500 mcg of chromium picolinate two times per day. The patients continued their regular medication. There was a significant dose and time dependent decrease in glycosylated hemoglobin, fasting glucose, two hour postprandial glucose levels, fasting and two hour after meal (postprandial) insulin values, and total serum cholesterol. Reversing a chromium deficiency by supplementing the diet with chromium has also been demonstrated to lower body weight while increasing lean body mass. All of the effects of chromium appear to be due to increased insulin sensitivity. A chromium deficiency may be an underlying contributing factor to the large number of Americans suffering from diabetes, hypoglycemia, and obesity. There is evidence that marginal chromium deficiency is common in the United States. Although no recommended dietary allowance (RDA) has been established for chromium, at least 200 mcg each day appears necessary for the most favorable sugar regulation. Chromium levels can be depleted by consuming refined sugars or white flour products, and by lack of exercise. In addition to the regular consumption of chromium rich foods, the diabetic and hypoglycemic should supplement the diet with chromium polynicotinate, chromium picolinate, or chromium enriched yeast. Vitamin C: A principal function of vitamin C is the manufacture of collagen, the main protein substance in the human body. Since collagen is such an important protein in connective tissue, vitamin C is vital for wound repair, healthy gums, and prevention of excessive bruising. In scurvy or severe vitamin C deficiency, the classic symptoms are bleeding gums, poor wound healing, extensive bruising, increased susceptibility to infection, hysteria, and depression. In addition to its role in collagen metabolism, vitamin C is critical to immune function, the manufacture of certain nerve transmitting substances and hormones, and the absorption and utilization of other nutritional factors. Since the transport of vitamin C into cells is facilitated by insulin, many diabetics do not have enough intracellular vitamin C. Therefore, a relative vitamin C deficiency exists in many diabetics despite ample dietary consumption. A chronic, latent vitamin C deficiency will lead to a number of problems for the diabetic, including an increased tendency to bleed (increased capillary permeability), poor wound healing, vascular disease, elevations in cholesterol levels, and a depressed immune system. Vitamin C at high doses (2,000 mg per day) has been shown to reduce the accumulation of sorbitol in the red blood cells of diabetics and to inhibit the glycosylation of proteins. As discussed before sorbitol accumulation and glycosylation of proteins are linked to many complications of diabetes, especially eye and nerve disease. The attempt to prevent sorbitol accumulation with drugs designed specifically to inhibit aldose reductase has produced equivocal results in human clinical trials along with consistent side effects. Vitamin C may be able to achieve what these drugs could not: safe and effective inhibition of sorbitol accumulation. A recent study provides further support for this possibility. In this research, vitamin C supplements of 100 mg or 600 mg were given daily for fifty eight days to young adults with insulin dependent diabetes. RBC sorbitol was measured at baseline and again at thirty and fifty eight days. The baseline results indicated that RBC sorbitol levels were nearly doubled in these patients despite sufficient dietary intakes of vitamin C. Supplementation at both dosages normalized RBC sorbitol within thirty days. This correction of sorbitol accumulation was independent of changes in diabetic control as monitored by fasting glucose, glycosylated hemoglobin, and presence of glucose in the urine. In fact, overall diabetic control during the study was moderate to poor. The researchers concluded: Vitamin C supplementation is effective in reducing sorbitol accumulation in the erythrocytes of diabetics. Given its tissue distribution and low toxicity, we suggest superiority for vitamin C over pharmaceutical ARIs [aldose reductase inhibitors]. Although lower levels of vitamin C achieved normal sorbitol levels, supplementation with a minimum of 2 grams of vitamin C daily in diabetics appears warranted due to its other important effects. While vitamin C supplementation will be necessary to ensure this level of intake, patients should be encouraged not to rely exclusively on supplements to meet all of their vitamin C requirements. Vitamin C rich foods are rich in flavonoids and carotenes, which enhance the effects of vitamin C and exert favorable effects of their own. Good dietary sources of vitamin C are broccoli, kale, peppers, potatoes, Brussels sprouts, and citrus fruits. Niacin and Niacinamide: Niacin containing enzymes play an important role in energy production; fat, cholesterol, and carbohydrate metabolism; and the manufacture of many body compounds, including sex and adrenal hormones. Like chromium niacin (vitamin B3, or nicotinic acid), is an essential component of the glucose tolerance factor, making it an important nutrient for treating hypoglycemia and diabetes. Supplementing the diet of diabetics with vitamin B3 in the form of niacinamide has been shown to produce many favorable effects. Foremost is its possible application in preventing the development of Type 1 diabetes. Niacinamide, also called nicotinamide, has been shown to prevent the development of diabetes in experimental animals. This observation led to several pilot clinical trials which suggest that niacinamide can prevent Type 1 diabetes from developing, or, if given soon enough at the onset of diabetes, may help restore beta cells or at least slow their destruction. To date their have been ten studies of niacinamide treatment in recent onset IDDM of less than five years duration. Six of these studies used a double blind placebo controlled format. Of these six, three studies showed a positive effect in terms of prolonged remission, lower insulin requirements, improved metabolic control, and increased beta cell function. Some newly diagnosed Type 1 diabetics have experienced complete reversal of their diabetes with niacinamide supplementation. The main difference between the positive and negative studies in recent onset IDDM seems to be the older age and higher baseline fasting C-peptide (an indicator of pancreatic function) in positive studies. In the spring of 1993, a large multi center study involving eighteen European countries, Israel, and Canada was started to follow up these encouraging preliminary findings. Other clinical trials are also in progress or have been proposed. The mechanism of action appears to be inhibition of damage to the beta cells by the immune system, along with niacinamide is based on body weight: 25 mg per kilogram. The studies in children used 100 mg to 200 mg per day. Niacin has also long been used to lower cholesterol levels. Because the dose of niacin required (1 gram three times daily) to lower cholesterol levels often results in skin, stomach irritation, ulcers, lover damage, fatigue, and other side effects, many diabetics do not tolerate niacin very well. The acute reaction of skin flushing after taking niacin can be alleviated by taking time release or slow release niacin products. These formulations allow the niacin to be absorbed gradually, thereby, reducing the flushing reaction. However, while these forms of niacin reduce skin flushing, they are more toxic to the liver. A better and safer form of niacin is inositol hexaniacinate (an unofficial B vitamin) and six molecules of niacin. Inositol hexaniacinate can be used in Type 1 and Type 2 diabetes to lower elevated blood lipid levels. This form of niacin has long been used in Europe to lower cholesterol levels and also to improve blood flow in patients with intermittent claudication (a condition characterized by severe muscle cramps in the calf produced with exercise or walking). It yields slightly better clinical results than standard niacin, including improved sugar level regulation, and is much better tolerated. In one study of 153 patients treated with inositol hexaniacinate at dosages ranging from 600 to 1800 mg per day, no patients reported any side effect or adverse reactions. In cases of elevated cholesterol levels, a dosage of 600 to 1000 mg three times a day is usually adequate to produce an 18% reduction in total cholesterol, a 26% reduction in triglycerides, and an increase of 30% in HDL cholesterol levels. Biotin: Biotin functions in the manufacture and utilization of carbohydrates, fats, and amino acids. Since biotin is manufactured in the intestines by gut bacteria, it is not often discussed as a needed nutrient. A vegetarian diet has been shown to alter the intestinal bacterial flora so that it enhances the synthesis and promotes the absorption of biotin. Biotin supplementation has been shown to improve insulin sensitivity and increase the activity of glucokinase, the enzyme responsible for the first step in the utilization of glucose by the liver. Glucokinase concentrations in diabetics are very low. In one study, 16 mg of biotin per day resulted in significant lowering of fasting blood sugar levels and improvements in blood glucose control in IDDM. In a study in NIDDM, similar effects were noted with 9 mg of biotin per day. If high dose biotin (greater than 8 mg per day) is used in IDDM, insulin requirements must be adjusted as needed. Vitamin B6: Vitamin B6 supplementation appears to offer considerable protection against the development of diabetic nerve disease (neuropathy), as diabetics with neuropathy have been shown to be deficient in vitamin B6 and to benefit from supplementation. Individuals with long standing diabetes, or who are developing signs of peripheral nerve abnormalities, should definitely be supplemented with vitamin B6. It is interesting to note that the neuropathy of vitamin B6 deficiency is indistinguishable from diabetic neuropathy. Vitamin B6 may also prove to be important in preventing other diabetic complications because it inhibits glycosylation of proteins. Vitamin B6 supplementation should be tried as a safe treatment for gestational diabetes. In one study of women with gestational diabetes, taking 100 mg of vitamin B6 for two weeks resulted in eliminating the diagnosis in twelve of the fourteen women. Vitamin B12: A vitamin B12 deficiency is characterized by numbness of the feet, pins and needles sensations, or a burning feeling – symptoms typical of diabetic neuropathy. Vitamin B12 supplementation has been used with some success in treating diabetic neuropathy. It is unclear if this is due to the correcting of a deficiency state or to the normalization of the deranged vitamin B12 metabolism seen in diabetics. Absence of anemia is not an adequate reason for ruling out a deficiency. A deficit within the nerve cells will usually precede anemia, often by several years. Measuring blood levels of vitamin B12 is more reliable in diagnosing vitamin B12 deficiency. Oral supplementation with 1,000 to 3,000 mcg per day is usually sufficient, but intramuscular injections of vitamin B12 may be required in some cases. Vitamin E: Diabetic appear to have an increased requirement for vitamin E. High doses of vitamin E (800 to 1,200 IU) not only improves insulin action, but also exerts a number of beneficial effects that may aid in preventing the long term complications of diabetes. Several clinical studies have shown vitamin E supplementation to be helpful. For example, in one study examining vitamin E’s role on glucose metabolism and insulin action, ten control (healthy) subjects and fifteen non insulin dependent diabetics underwent an oral glucose tolerance test before and after taking 1,350 IU of vitamin E per day for four months. In the healthy subjects, vitamin E supplementation was shown to improve glucose tolerance and insulin sensitivity. In the diabetics, improvements in glucose metabolism and insulin action were even more obvious. The authors of the study concluded: Our study demonstrates that in diabetic patients daily oral vitamin E supplements may reduce oxidative stress, thus improving membrane physical characteristics and related activities in glucose transport. Vitamin E also appears to play a significant role in the prevention of diabetes. One study followed 944 men, forty two to sixty years of age, who did not have diabetes at the beginning of the study. Forty five men developed diabetes during the four year follow up. The study indicated that a low vitamin E concentration was associated with 3.9 times greater risk of developing diabetes. Magnesium: Magnesium is involved in several areas of glucose metabolism, and there is considerable evidence that diabetics need supplemental magnesium. The reason for this is magnesium deficiency in diabetics is common and magnesium may prevent some of the complications of diabetes, such as retinopathy and heart disease. Magnesium levels are lowest in diabetics who have severe retinopathy. The RDA for magnesium is 350 mg per day for adult males and 300 mg per day for females. The diabetic may need twice the amount. While the magnesium should ideally be derived from diet, the average intake of magnesium by healthy adults in the United States ranges only between 143 and 266 mg per day. While magnesium can be found in abundance in whole foods, food processing refines out a large portion of magnesium. The best dietary sources of magnesium are tofu, legumes, seeds, nuts, whole grains, and green leafy vegetables. Fish, meat, milk, and the most commonly eaten fruits are quite low in magnesium. As most Americans consume a diet high in refined foods, meat, and dairy products, low magnesium intake is common. In addition to eating a diet high in magnesium rich foods, supplementation with 300 mg to 500 mg of vitamin B6 per day; the level of intracellular vitamin B6 appears to be intricately linked to the magnesium content of the cell. Put simply, without vitamin B6, magnesium will not get inside the cell. Potassium: There are several reasons why diabetics should eat a high potassium diet: potassium supplementation produces improved insulin sensitivity, responsiveness, and secretion; insulin administration induces a loss of potassium; and a high potassium intake reduces the risk of heart disease, atherosclerosis, and cancer. However, there are a number of concerns about potassium supplementation in diabetics. The estimated safe and satisfactory daily dietary intake of potassium, as set by the Committee of Recommended Daily Allowances, is 1.9 g to 5.6 g. If body potassium requirements are not being satisfied through diet, supplementation is important to good health. This is particularly true for diabetics as well as athletes and the elderly. Potassium salts are commonly prescribed by physicians in the dosage range of 1.5 g to 3.0 g per day. However, potassium salts can cause nausea, vomiting, diarrhea, and ulcers. These effects are not seen when potassium levels are increased through the diet only. This highlights the advantages of using vegetable juices, foods, or food based potassium supplements to meet the human body’s requirements. While most people can handle an surplus of potassium, those with diabetes and kidney disease do not handle potassium in the normal way, and are most likely to experience heart disturbances and other consequences of potassium toxicity. Individual with kidney disorders usually need to restrict their potassium intake. Most diabetics can consume a high potassium diet, but their kidney function should be properly evaluated before taking a potassium supplement. Manganese: Manganese is a cofactor in many enzyme systems involved in blood sugar control, energy metabolism, and thyroid hormone function. In guinea pigs, a deficiency of manganese results in diabetes and the frequent birth of offspring who develop pancreatic abnormalities or have no pancreas at all. Diabetics have been shown to have only 50% the manganese of normal individuals. A good daily dose of manganese for a diabetic is 30 mg. Zinc: Zinc is involved in virtually all aspects of insulin metabolism: synthesis, secretion, and utilization. Zinc also has a protective effect against beta cell destruction. Diabetics typically excrete excessive amounts of zinc in the urine and therefore require supplementation, which has been shown to improve insulin levels in both Type 1 and Type 2 diabetes. In addition, zinc helps improve the poor wound healing observed in diabetics. Zinc is found in good amounts in whole grains, legumes, nuts, and seeds. The recommended level of supplementation for diabetics is a least 30 mg of zinc per day. Flavonoids: Recent research suggests that flavonoids may be valuable in treating diabetes. Flavonoids such as quercetin promote insulin secretion and are potent inhibitors of sorbitol accumulation. These effects may help explain the favorable effects of many botanical medicines traditionally used in the treatment of diabetes, many of which are high in flavonoids. The nutritional effects of flavonoids include: an increase intracellular vitamin C levels, a decrease in the leakiness and breakage of small blood vessels, the prevention of easy bruising, and immune system support, all of which are of benefit to individual with diabetes. In addition to consuming a diet rich in flavonoids, the diabetic should take an extra 1 to 2 grams of mixed flavonoids per day or a flavonoid rich extract such as bilberry or grape seed extract. Essential Fatty Acids: Both omega 6 and omega 3 fatty acids have shown benefit in treating various aspects of diabetes. In particular, the omega 6 fatty acid, gamma linolenic acid, has been shown to offer significant protection against the development of diabetic neuropathy, while the omega 3 oils offer significant protection against hardening of the arteries and enhance insulin secretion in NIDDM. To sum up the following discussion, it appears that the best approach is to: Increase the consumption of cold water fish such as salmon, herring, mackerel, and halibut. Supplement the diet with 480 mg of gamma linolenic acid from evening primrose, borage, or black currant oil. Consume 1 tablespoon of flaxseed oil daily. Gamma Linolenic Acid: Diabetes is associated with a substantial disturbance in essential fatty acid (EFA) metabolism. One of the key disturbances is the impairment in the process of converting linoleic acid to gamma linolenic (GLA), dihomo gamma linolenic (DHGLA), and arachidonic acids. As a result, providing GLA in the form of borage, evening primrose, or black currant oils may offer a method to sidestep some of this disturbance. To test the theory, a large multicenter trial was designed. The Gamma Linolenic Acid multicenter Trial enrolled 111 patients with mild diabetic neuropathy from seven centers into a randomized, double blind, placebo controlled parallel study of GLA at a dose of 480 mg/day for one year. The source of GLA used in the study was evening primrose oil. Patients in the treatment group took twelve capsules containing 40 mg of GLA per day. Sixteen different parameters were evaluated, including condition velocities, hot and cold thresholds, sensation, tendon reflexes, and muscle strength. After one year, all sixteen parameters improved, thirteen of them to a statistically significant degree. Treatment was more effective in relatively well controlled than in poorly controlled diabetic patients. The latter finding highlights the need for a comprehensive approach in controlling blood sugar levels rather than expecting a single physiological aid to compensate for poor control. Omega 3 Fatty Acids: The omega 3 fatty acids have been shown to lower cholesterol and triglyceride levels in hundreds of studies, including many studies of diabetics. However, not all of the studies have produced positive effects. In fact, some studies have shown deterioration of blood sugar control and elevations in blood lipid levels. Although there is not obvious explanation for these contradictory finding, proper dosage and antioxidant support (especially vitamin E) appears to be critical to producing beneficial rather than deleterious effects. The initial enthusiasm for the use of fish oils (eicosapentaenoid acid) [EPA] and docosahexanoic acid [DHA]), in treating diabetes was modified by reports of potentially damaging effects, including increased levels of plasma glucose, total cholesterol, and LDL cholesterol. The magnitude of these unfavorable effects was relatively small, but nonetheless their occurrence raised doubts concerning the safety of fish oil supplementation for diabetics. These adverse effects occurred at larger doses, usually 4 to 10 grams of fish oils per day. Subsequent studies using lower doses (2.5 grams of omega 3 fatty acids) or highly purified EPA (900 mg or 1,800 mg per day) have led to a better understanding of he potential problems with fish oils. Specifically, dosage appears to be a critical element. At the lower dosage of 2.5 g of fish oils or 900 mg of purified EPA, supplementation appears safe. In one study, a 96% pure EPA product at a dose of 900 mg per day had little effect on blood sugar. However, at 1,800 mg per day for eight weeks, blood sugar control deteriorated and cholesterol levels increased dramatically. Altogether, these studies seem to advocate proceeding with caution when using fish oil supplements for diabetes. One reason why fish oil products may negatively affect diabetics is the high levels of lipid peroxides in these preparations, coupled with their tendency to deplete antioxidant nutrients when ingested. Diabetics might better gain the benefits of omega 3 oils by consuming fish and/or flaxseed oil, neither of which is associated with negative effects in diabetes. Increased consumption of cold water fish has been shown to produce effects equal or superior to fish oil supplementation. For example, in one study, twenty five men with high cholesterol levels were studied over a five week period, comparing the effects of eating an equivalent amount of fish oil from whole fish versus a fish oil supplement. Although total cholesterol levels were unchanged in both groups, both fish and fish oil supplements lowered triglycerides and raised HDL cholesterol. However, dietary fish produced some additional benefits over the fish oil supplements including better effects on improving blood viscosity. These findings imply that, while both fish consumption and fish oil supplementation produce desirable effects on lipids and lipoproteins, fish consumption is more effective in improving several other factors involved in cardiovascular disease. Another study demonstrated an inverse correlation between fish intake and impaired glucose tolerance and diabetes. An average daily intake of 24.2 g (about one ounce) of fish was associated with a significantly lower incidence of glucose intolerance. In addition, mortality was lower in fish consumers (20.6 /1000 person years) compared to those who did not eat fish (31.2/1000 person years). These studies, along with additional epidemiological studies showing a low prevalence of both IDDM and NIDDM in cultures that consume cold water fish; this may be an indication that omega 3 fatty acids may offer some protection against the development of diabetes. Although the majority of studies on omega 3 oils have utilized fish oils, flaxseed oil may offer similar benefits because it contains alpha linolenic acid (ALA), an omega 3 oil which the body can convert to EPA. Linolenic acid exerts many of the same effects as EPA, as well as several of its own, including affecting the immune system, fighting cancer, and exerting a greater positive effect on platelet function. Flaxseed oil supplementation may evade some of the problems associated with EPA supplementation in diabetics. In the presence of omega 6 fatty acids, ALA is not as effective in increasing tissue concentrations of EPA and lowering tissue concentrations of arachidonic acid. In contrast to EPS, this moderate effect of flaxseed oil in the presence of omega 6 oils may not compromise the already disturbed EPA metabolism of the diabetic. Furthermore, encapsulated fish oils have several disadvantages: they contain very high levels of lipid peroxides, they deplete body stores of antioxidant nutrients, and they are expensive to use at therapeutic dosages (1.8 g EPA/day for most clinical applications). Flaxseed oil will most likely emerge as the preferred source of omega 3 fatty acids in the treatment of diabetes as well as in atherosclerosis, high blood pressure, and inflammatory conditions such as psoriasis, rheumatoid arthritis, eczema, multiple sclerosis, and ulcerative colitis. In summary, diabetics can benefit from omega 3 oils. At this time the best recommendation may be to increase the amount of cold water fish in the diet and use flaxseed oil. An average daily intake of 1 ounce of fish is appropriate. This amount works out to roughly tow 3.5 ounce servings per week. For flaxseed oil, a daily dosage of 1 tablespoon is recommended for diabetics. Carnitine: Carnitine supplementation has resulted in significantly decreased total serum lipid and increased HDL cholesterol levels in diabetic patients. In addition, carnitine increases the breakdown of fat into energy (a process known as beta oxidation), possible playing a role in preventing diabetic ketoacidosis. Inositol: As mentioned prior, inositol supplementation has shown some success in the treatment of experimental animal diabetic neuropathy since it helps reestablish normal levels of myoinositol in nerve cells. The nerve cell myoinositol deficiency is believed t result from a combination of glucose competition with myoinositol for active transport into the cell and accumulation of sorbitol within the cell, resulting in the loss of intracellular myoinositol. Oral supplementation in human diabetics has not, however, resulted in significant clinical improvement. Botanical Medicines Before the arrival of insulin, diabetes was treated using plant medicines. In 1980, the World Health Organization urged researchers to examine whether traditional medicines produced any favorable clinical results. In the last ten to twenty years, scientific investigation has confirmed the efficacy of many of these preparations, some of which are remarkably effective. Covered below are those plants which appear most effective, are least toxic, and have substantial documentation of efficacy. Even though the herbs discussed possess blood sugar lowering effects, proper and effective natural treatment of the diabetic patient requires the careful integration of diet, nutrition supplements, lifestyle, and botanical medicine. Onion and Garlic: Onions and garlic have demonstrated blood sugar lowering action in several studies. The active principles are thought to be sulfur containing compounds – allyl propyldisulphide (APDS) in onions, and diallyl disulphide oxide (allicin) in garlic – although other constituents such as flavonoids may play a role as well. Experimental and clinical evidence suggests that APDS lowers glucose levels by competing with insulin (also a disulphide) for insulin inactivating sites in the liver. This results in an increase of free insulin. APDS administered in doses of 125 mg/kg to fasting humans causes a marked fall in blood glucose levels and an increase in serum insulin. Allicin at doses of 100 mg/kg produces a similar effect. Increasing the graded doses of onions extracts to levels sometimes found in the diet (1 to 7 ounces of onion) reduce blood sugar levels in a dose dependent manner – the higher the intake of onion extract, the lower the level of glucose during oral or intravenous glucose tolerance test. The effects are similar in both raw and boiled onion extracts. The cardiovascular effects of garlic and onions (lowering cholesterol and blood pressure) further substantiate the value of liberal intake of garlic and onions by the diabetic patient. Bitter Melon (Momordica charantia): Bitter melon – also known as balsam pear – is a tropical fruit widely cultivated in Asia, Africa, and South America. A green cucumber shaped fruit covered with gourd like bumps, bitter melon looks like an ugly cucumber. In addition to an unripe fruit being eaten as a vegetable, bitter melon has been used extensively in folk medicine as a remedy for diabetes. The blood sugar lowering action of the fresh juice or extract of the unripe fruit has been clearly established in human clinical trials as well as experimental models. Bitter melon is composed of several compounds with confirmed anti-diabetic properties. Charantin, extracted by alcohol, is a hypoglycemic agent composed of mixed steroids that is more potent than the oral hypoglycemic drug Tolbutamide. Momordica also contains insulin like polypeptide, polypeptide-P, which lowers blood sugar levels when injected like insulin into Type 1 diabetics. Since it appears to have fewer side effects than insulin, it has been suggested as a replacement for various patients. Unfortunately, there is no further research in this area. The oral administration of bitter melon preparation has shown good results in clinical trials in patients with Type 2 diabetes. In one study, blood sugar control was improved in 73% of Type 2 diabetics who were given 2 ounces of the juice. The total area under the glucose tolerance curves of the patients responding to the bitter melon was 187.0 cm, much lower than the baseline level of 243.6 cm. In another study, 15 grams of the aqueous extract of bitter melon produced a 54% decrease in after meal blood sugar level and a 71% reduction in glycosylated hemoglobin in six patients. Unripe bitter melon is available primarily at Asian grocery stores. Commercial suppliers and health food stores may have bitter melon extracts, but the fresh juice is probably the best as this traditional form was used in some of the studies. Bitter melon juice is very tricky to make palatable because, as its name implies, it is quite bitter. If you use this effective plant medicine, hold your nose and quickly drink a 2 ounce shot of the juice. The dosage of other forms should approximate this dose. Gymnema sylvestre: Gymnema sylvestre, a plant native to the tropical forests of India, has long been used as a treatment for diabetes. Recent scientific investigation has upheld its effectiveness in both Type 1 and Type 2 diabetes. Gymnema sylvestre appeared on the U.S. market a few years ago, hyped as a sugar blocker. Manufacturers inaccurately claimed that Gymnema could allow sugar to pass through the gastrointestinal tract unabsorbed. Outlandish advertisements contained phrases such as how to cut down on sugar calories without cutting down sugar. When applied to the tongue, Gymnema components, such as gymnemic acid, block the sensation of sweetness. Clinically this has shown some importance. Subjects that had Gymnema extracts applied to their tongue have been shown to consume fewer calories at a meal, compared to controls. Consumption of capsules or tablets has not been shown to produce the same effect. Gymnema extracts have been shown to enhance glucose control in diabetic dogs and rabbits. Interestingly, Gymnema has no apparent effect in animals that have had their pancreas removed, suggesting that Gymnema enhances the production of insulin. There is evidence in animal studies that it accomplishes this through regeneration of the insulin producing beta cells in the pancreas. Studies in humans with both types of diabetes also seem to support the possibility of pancreas regeneration. Gymnema extract has shown positive clinical results in both Type 1 and Type 2 diabetes. An extract of the leaves of Gymnema sylvestre given to twenty seven patients with Type 1 diabetes on insulin therapy was shown to reduce insulin requirements and fasting blood sugar levels, and to improve blood sugar control. In Type 1 diabetes, Gymnema appears to enhance the action of insulin. In a study of Type 2 diabetics, twenty two were given Gymnema extract along with their oral hypoglycemic drugs. All patients demonstrated improved blood sugar control; twenty one of the twenty two were able to reduce their drug dosage considerably; and five subjects were able to discontinue their medication and maintain blood sugar control with the Gymnema extract alone. It is interesting to not that Gymnema extract given to healthy volunteers does not produce any blood sugar lowering or hypoglycemic effects. The dosage for Gymnema sylvestre extract is 400 mg per day in both Type 1 and Type 2 diabetes. No side effects have been reported from Gymnema extract. Fenugreek (Trigonella foenumgraecum): Fenugreek seeds have demonstrated noteworthy anti diabetic effects in experimental and clinical studies. The active principle is in the defatted portion of the seed. Administration of the defatted seed (in daily doses of 1.5 to 2 g/kg) to both normal and diabetic dogs has reduced fasting and postprandial blood levels of glucose, glucagon, somatostatin, insulin, total cholesterol, and triglycerides, while increasing HDL cholesterol levels. Human studies have confirmed these effects. Defatted fenugreek seed powder given twice daily, at a 50 gram dose, to insulin dependent diabetics, resulted in significant reduction in fasting blood sugar levels, and improved glucose tolerance test results. There was also a 54% reduction in twenty four hour urinary glucose excretion, and significant reductions in cholesterol and triglyceride values. In insulin dependent diabetics, supplementation with 15 grams of powdered fenugreek seed soaked in water significantly reduced after meal glucose levels during the meal tolerance test. These results indicate that fenugreek seeds or defatted fenugreek seed powder should be include in the diet of the diabetic. Salt Bush (Atriplex halimu): Salt bush is a branch, woody shrub native to Mediterranean, North Africa, and Southern Europe. Salt bush is chiefly common around the Jordan Valley in inundated saline depressions and oases. Researchers noticed that when sand rats switched from a diet rich in salt bush to standard rat chow, they would characteristically develop severe diabetes. Restoring Atriplex to the diet brought about a quick reversal of the condition. Human studies conducted in Israel demonstrated improved blood glucose regulation and glucose tolerance in patients with Type 2 diabetes. Salt bush is rich in fiber, protein, and numerous trace minerals, including chromium. The dosage used in the human studies was 3 grams per day. Pterocarpus marsupium and Epicatechin – Containing Plants: Pterocarpus has a long history of use in India as a treatment for diabetes. The flavonoid epicatechin, extracted from the bark of this plant, has been shown to prevent beta cell damage in rats. Further, both epicatechin and a crude alcohol extract of Pterocarpus marsupium have been shown t actually regenerate functional pancreatic beta cells in diabetic animals. Epicatechin and related flavonoids are very strong antioxidants. In addition to Pterocarpus, the dry weight percentage of epicatechin is very high in a number of other plants, most notably green tea (Camellia sinensis; one to three percent). As commercial sources of Pterocarpus are lacking in the United States, green tea may be a suitable alternative. The recommended dosage is at least two cups of green tea per day, or 300 mg of green tea extract. Bilberry (Vaccinium myrtillus): Bilberry, or European blueberry, is a shrubby perennial plant that grows in the woods and forest meadows of Europe. The fruit is a blue black berry that differs from an American blueberry in that its meat is also blue black. Bilberry leaf tea has a long history of folk use in the treatment of diabetes. This use is supported by research which has shown that oral administration reduces blood sugar levels in normal and diabetic dogs, even when glucose is injected intravenously at the same time. Although this research is interesting, it is thought that the berries or extracts of the berries offer even greater benefit. It appears that anthocyanosides have an affinity for the blood vessels of the eye and the retina, especially the macula (the area of the retina responsible for fine vision), and improve circulation to the retina. This affinity is consistent with several of the clinical effects observed, including positive results in diabetic retinopathy, macular degeneration, cataracts, retinitis pigmentosa, and night blindness. Bilberry extracts have been prescribed for diabetic retinopathy in France since 1945. The standard dose for bilberry extracts is based on its anthocyanosides content, as calculated by its anthocyanidin percentage. Widely used pharmaceutical preparations in Europe are standardized for anthocyanidin content (generally 25%). These extracts are also available in the United States. The standard dose is 80 to 160 mg three times daily. Ginkgo biloba: Although the primary clinical application of Ginkgo biloba extract (GBE) is cerebra vascular insufficiency, GBE has also been shown to improve the blood flow to peripheral tissues in the arms, legs, fingers, and toes. This is an important effect, as peripheral vascular insufficiency is common in diabetics. In several double blind trials in patents with intermittent claudication, ginkgo was shown to be quite active and superior to the placebo. Not only were measurements of pain free walking distance and maximum walking distance dramatically increased, but ultrasound measurements demonstrated, increased blood flow through the affected limb. The significance of demonstrating measurable improvement in blood glow through the affected areas is great. While conventional medical treatment of these patients (muscular rehabilitation and the elimination of risk factors such as smoking, excess weight, etc.) results in clinical improvement, such as increased walking tolerance, it has not shown improved blood flow of the limbs, and the results are limited over time. Therefore, the muscular rehabilitation and elimination of risk factors, while valuable therapies, are not satisfactory alone. Ginkgo is clearly an important medicine in the treatment of peripheral vascular disease due to diabetes. Ginkgo biloba extract has also been shown to prevent diabetic retinopathy in diabetic rats, suggesting that it may have a protective effect in human diabetics. The dosage of the Ginkgo biloba extract standardized to contain 24% ginkgo flavonglycosides is 40 to 80 mg three times a day. Ginseng: In a double blind controlled study, thirty six non insulin dependent diabetic patients were treated for eight weeks with ginseng at either 100 mg, 200 mg daily, or a placebo. Ginseng elevated mood, improved psychophysiological performance, and reduced fasting blood sugar levels and body weight. The 200 mg dose improved glycosylated hemoglobin levels and physical activity. Exercise An appropriate exercise training program is vitally important in a diabetes treatment plan. Exercise improves diabetes on many levels and is recommended for both IDDM and NIDDM. Physically trained diabetics experience many benefits: enhanced insulin sensitivity with a consequent diminished need for exogenous insulin, improve glucose tolerance, reduced total serum cholesterol and triglycerides with increased HDL levels that result in a more anti-atherogenic state, and improved weight loss in obese diabetics. However, the physical fitness program does present some risk to the diabetic and must be carefully tailored to the fitness of the patient. Exercise should be avoided during periods of hypoglycemia. In addition to its well known and documented value, exercise may have a more specific beneficial value, exercise may have more specific beneficial effects for diabetics: exercise increases tissue levels of chromium in rats and increases the number of insulin receptors in IDDM patients. It is possible, the, that many of the beneficial effects of exercise are directly related to improved chromium metabolism.
Encyclopedia of Natural Medicine Smart Medicine for Healthier Living Natural Supplements for Diabetes
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| Gylcemic Index of Common Foods Sugars Glucose - 100 Maltose - 105 Honey - 75 Sucrose - 60 Fructose - 20 Fruits Apples - 39 Bananas - 62 Oranges - 40 Orange Juice - 46 Raisins - 64 Vegetables Beets - 64 Carrot, Raw - 31 Carrot Cooked - 36 Potato, baked - 98 Potato (new), boiled - 70 Grains Bran cereal - 51 Bread, white - 69 Bread, whole grain - 72 Corn - 59 Cornflakes - 80 Oatmeal - 49 Pasta - 45 Rice - 70 Rice, puffed - 95 Wheat cereal - 67 Legumes Beans - 31 Lentils - 29 Peas - 39 Other foods Ice cream - 36 Milk - 34 Nuts - 13 Sausages - 28 |
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