By Andrew Gaeddert
Diabetes affects 16 million people in the U.S. It is the fourth leading cause of death, is the principle cause of blindness, and the most common cause of kidney failure. Many people have diabetes but don’t know it. Ty pe I diabetes, often called juvenile onset diabetes, affects 5 percent of the diabetic population. People with Type I diabetes are dependent on insulin. Type II diabetes, or non-insulin dependent diabetes, usually affects adults and can run in families. In recent years there is a dramatic increase in Type II diabetes due to hereditary factors, diets rich in processed foods, and lack of regular exercise. What was once referred to as adult onset diabetes (Type II) is now affecting obese children.
Many experts see diabetes as a marker for aging, as diabetics have been known to develop higher cholesterol and typically die of heart disease at a younger age than non-diabetics. It is hypothesized that elevated glucose generates a large number of free radicals, which damage cells.
When people hear about problems with glucose and insulin, they normally think of diabetes. Diabetes is only one condition that exhibits these symptoms. In 1988, Stanford endocrinologist Gerald Reaven, M.D., coined the term Syndrome X. Syndrome X refers to conditions brought about by excessive refined carbohydrate diets. This includes two or more of the following: insulin resistance, elevated cholesterol or triglycerides, abdominal obesity, and high blood pressure. Having Syndrome X increases one’s odds of getting diabetes or heart disease. The easiest way to diagnose insulin resistance is with a glucose tolerance test. In abdominal obesity (“beer gut”, “pot belly”), glucose is stored as fat. Genetically this has helped our species during times of famine. As the number of fat cells increase, the relative percentage of muscle cells decreases, reducing the number of sites for insulin to function. Obesity increases the risk of diabetes, heart disease, and some cancers; obese women are more likely than thin women to develop breast cancer. Cholesterol and triglycerides are associated with an increased risk of heart disease and stroke, however cholesterol is vital to the making of steroid hormones such as testosterone and estrogen. In Syndrome X, there may be a high total cholesterol, low good HDL cholesterol, high LDL to HDL cholesterol ratio, or high triglyceride levels. There may also be oxidized LDL cholesterol.
The body strives to maintain a balance of glucose (blood sugar). After meals, the body responds to the rise in blood glucose by secreting insulin, a hormone produced by the beta cells of the pancreas. Insulin lowers blood glucose by increasing the rate at which cells throughout the body absorb glucose. Decline in blood glucose causes the release of glucagon, a hormone produced by the alpha cells of the pancreas. Glucagon stimulates the release of glucose stored in body tissues, especially the liver. If the blood glucose falls rapidly or if a person is angry or fearful, the result causes a release of epinephrine (adrenaline) and corticosteroids by the adrenal glands. These chemicals have the power to break-down stored glucose to provide extra energy to cope with a crisis. Insulin can increase blood pressure in a number of ways. It can increase the retention of sodium, increase the secretion of cortisol, a stress hormone, as well as triggering the sympathetic nervous system to speed up heart rate and blood pressure. Increased blood flow in the arteries can be due to obesity, as the heart has to pump harder either through a larger body, or because of atherosclerosis (hardening of the arteries) which makes the vessels less elastic. (Given equal water pressure, water moves through a narrow hose faster and with greater pressure than it does through a wider hose.) Hypertension can lead to heart disease, stroke and kidney disease, and is also associated with memory loss and Alzheimer’s disease.
SUGAR OVERLOAD
Causes of diabetes and Syndrome X include stress, excessive amount of processed foods and lack of exercise. Physical and psychological stress increase cortisol levels, which reduces the ability of glucose to get into the cells, as well as being a risk factor for heart disease and Alzheimer’s disease. Fatigue, mental exhaustion, and anger are associated with excess levels of cortisol.
Sweeteners including sugar, fructose, sucrose, maltose, lactose, corn syrup, and grape concentrate are consumed at alarming rates. The average U.S. consumption of sugar is over 150 pounds per person, per year, as compared with residents in the 1800’s who consumed 12 pounds per year. If we go back further, sugar was rarely consumed at all, the main source of sweets being honey and whole fruits. In addition to being damaging on their own, sugars provide empty calories, which replace nutrient dense foods. High carbohydrate diets, smoking, radiation, or pollution generates free radicals in the body, and thus increases the need for antioxidant vitamins. Sugar increases LDL cholesterol and triglycerides and makes platelet cells aggregate, which tends to contribute to heart disease and stroke. It also reduces levels of calcium and phosphorus, which are needed to maintain healthy bones.
COMPLICATIONS OF DIABETES
Chronic health problems associated with diabetes include atherosclerosis, diabetic neuropathy, diabetic retinophathy, diabetic foot ulcers and kidney disease. Hypoglycemia, or low blood sugar, is much more common in Type I diabetes. Taking too much insulin, missing meals or overexerting for one’s constitution can cause hypoglycemia. Sweating, nervousness, headache, tremor, hunger, and unpleasant dreams may all be signs of hypoglycemia. Diabetic ketoacidosis, more common in Type I diabetes, can result in a build up of ketones or ketoacides, which are produced by the breakdown of fat by-products. Diabetics must measure levels of ketones in the urine to prevent ketoacidosis, which can increase urination and thirst, fatigue, nausea, vomiting and if untreated, a coma. Nonketogenic Hypersmolar Syndrome is caused by severe dehydration caused by lack of fluid intake, burns, stroke, pneumonia, and certain drugs such as diuretics, glucosorticoids, diazoside, and phenytoin.
MEDICATIONS IN DIABETES
Standard medications for diabetes include, cholorpropamide (Diabinese), glipizide (Glucotrol), glyuride (Micronase), tolazamide (Tolinase) and tolbutamide (Orinase). They are not typically effective. After three months of continual treatment, they fail to adequately control blood sugar in 40 percent of the cases. Even for the responders, usually the effects wear off. The long-term success at being able to control blood sugar levels is only about 30 percent (Murray, Michael, Diabetes and Hypoglycemia, Roseville, CA: Prima Publishing, 1994, p. 15). As they are sulfa compounds they must not be taken by those who have an allergy to sulfa drugs. Typical side effects include digestive and skin reactions, headache, fatigue, and liver damage. In some cases insulin needs to be prescribed with these drugs. Metformin (Glucophage), perhaps the most popular diabetes drug, improves insulin resistance but may increase the risk of heart disease by reducing levels of folic acid, vitamin B-12, and increased homocysteine. It can also cause headache, dizziness, fatigue and digestive symptoms. The New England Journal of Medicine reported that moderate exercise (walking an average of 30 minutes a day, five days a week) and dietary changes (lowering fat and overall calorie intake) were found to be more effective than metformin (Glucophage) in delaying and possibly preventing Ty pe II diabetes in a study of 3,234 overweight people with impaired glucose tolerance (IGT), a precursor of diabetes. Where the diet and exercise regime achieved a 5 to 7% weight loss, it reduced diabetes incidence by 58% compared to 31% in the metformin group, both at 3 year follow-ups. (New England Journal of Medicine, Vol. 346:393-403).
DIET
Caloric restriction leads to greater insulin sensitivity. Therefore eating more nutritious foods and fewer refined carbohydrates, incorporating good fats into the diet, and eliminating unhealthy fats can lower glucose and insulin levels, and reduce glucose damage to the body. Studies at the University of Naples in Italy have shown that those who live past 100 were trimmer, had less body fat, and were less likely to have pot bellies than those in their 40’s (Jack Challem, et al, Syndrome X, New York: John Wiley & Sons, 2002, p. 37). Typically they ate 5 times as much vegetables.
Emphasize fresh vegetables and fruits, extra virgin oil for cooking, flax or avocado oil for dressing, and avoid soft drinks, fruit juices, alcohol, fried foods (which contain trans-fatty acids), and margarine. Lean protein with every meal can help to stabilize blood glucose levels: particularly helpful are fish including salmon, trout, tuna, sardines, herring, anchovies, and mackerel. Increase exercise by walking, gardening, dancing, swimming, and biking; exercising has numerous health benefits and increases insulin sensitivity.
SUCCESS WITH NATURAL METHODS
Careful attention to one’s symptoms, home glucose monitoring, and careful diet are all important to success with natural therapies. The herbs mentioned below are all bio-active in pill form which is more applicable for Americans in long term treatment. For example, unripe bitter melon has a glucose lowering effect but must be taken as a fresh juice or daily decoction, therefore it is not likely to be successfully used by American diabetics.
COROSOLIC ACID (QUEENS CREPE MYRTLE, LAGERSTROEMIA SPECIOSA)
Corosolic acid is extracted from the Asian tree Queen’s Crepe Myrtle (Lagerstroemia speciosa). It is one of the more promising blood sugar regulating plants because a low dosage of the extract is still effective. Laboratory studies in Japan have indicated that Corosolic acid is an activator of glucose transport and has a hypoglycemic effect when used orally. In a placebo controlled study in Japan, patients with fasting glucose levels of 110 mg/dl, were given a placebo or standardized Queen’s crepe myrtle tablets equaling 160 mcg of Corosolic acid. A statistically significant drop in blood glucose was seen in most patients. In an American study with ten Type II diabetic patients, average blood glucose dropped 31.9 percent after two weeks of administration of a preparation consisting of 480 mcg of Corosolic acid. When normal volunteers were given the same preparation, they were not affected in one study. In the other study the equivalent of 240 mcg of corosolic acid produced a hypoglycemic effect, but volunteers recovered to normal blood glucose levels in three hours.
The most recent, a 60 day experiment, was conducted on 9 male and female Type II diabetics, ranging in age from 37-72. Each participant was given 16 mg of Queen Crepe Myrtle extract containing 1% corosolic acid in capsule form, 3 times per day, one after each meal. Blood was drawn from the volunteers under fasting, and serum glucose levels were estimated using enzymatic glucose oxidase/peroxidase method within 60 minutes of blood collection. The results showed an average reduction of 15% in fasting serum glucose levels within 15 days. Within 30 days the average reduction was 19.96% and 22.08% after 60 days. The results are almost identical to the first study, which was only 30 days and comprised 8 volunteers. The first study resulted in an average reduction of 15% after 15 days and 19% after 30. All participants benefited from the use of Queen’s Crepe Myrtle with an average reduction of 22% (Challem, pp. 228-29).
GINSENG
Ginseng has been used since ancient times as a treatment for diabetes symptoms. Although all ginseng species have hypoglycemic effects in laboratory models, American Ginseng (Panax quinqefolium) is the preferred species because it is cooling and generates fluids and is traditionally used for thirst, fatigue, and hunger. Empirically, it has been used to treat diabetes.At the University of Toronto, researchers conducted several studies testing the effects of American ginseng on glucose levels. Twelve healthy individuals received either a placebo or 1,2, or 3 grams of American ginseng at various time intervals before a capillary blood and glucose challenge test was administered. Glycemia was lowest 40 minutes after dosages of American ginseng. According to the researchers, each dosage worked equally as well. Similar findings were observed in three additional human studies. (American ginseng attenuates postprandial glycemia in a time-dependent but not dose-dependent manner in healthy individuals, Vuksan, V., et al, “American Journal of Clinical Nutrition”, Vol. 73, No. 4, 753-758, April 2001).
Toronto researchers concluded that American ginseng stimulates insulin secretion and improves nitric oxide-mediated uptake of glucose into cells, and this may explain why non-diabetics get the best effect taking American ginseng 40 minutes prior to a glucose challenge. Regulating glycemia is important to people with diabetes and Syndrome X, as poor control of postprandial glucose levels increases the risk of developing atherosclerosis and death due to cardiovascular disease. High blood glucose concentration is a risk factor for mortality in middle- aged nondiabetic men. (Diabetes Care, 1998; 21 (3) 360-7.)
MILK THISTLE
Milk Thistle has been found to be beneficial in a wide range of liver disorders. Eighty percent silymarin extracts of milk thistle (for example, a 200 mg capsule or tablet of milk thistle will have 160 mg of silymarin) have been found to have antioxidant and glucose regulating properties.
In a study at Monfalcone Hospital in Groiza, Italy, 60 insulin dependant diabetics took either 600 mg of silymarin or a placebo for 12 months. After the first month, in which fasting glucose levels were elevated, fasting glucose declined by 9.5 percent and average daily glucose dropped 14.9 percent among the treated group. In addition, glucosuria (sugar in the urine), and glycosylated hemoglobin, and insulin requirements declined significantly (Challem, p. 220).
STEVIA
Stevia, a South American herb, has glucose lowering properties when taken in large dosages and is considered a natural sweetener. It is sold in health food stores in dry leaf form,powder,and alcohol tincture. The author has found stevia very useful in helping clients wean off of sugar and sugar substitutes.
TCM FORMULAS
Although Traditional Chinese formulas are very helpful at treating constitutional factors and various symptoms, they have not been widely studied for their glucose lowering effects. Formulas such as Drain Dampness (Wu Ling San) may be used to reduce water weight. Formulas such as Astra Essence may be used to reduce night time urination and has a mild hypoglycemic effect. Lily Bulb (Bai He Gu Jin Tang) can be used for chronic thirst and dryness.
CAUTIONS, CONTRAINDICATIONS, AND CONCLUSIONS
Before trying herbs, it is essential that diabetics be under the care of a knowledgeable health professional. In addition to glucose monitoring, it is imperative to emphasize exercise, stress reduction and the importance of a diet emphasizing fresh vegetable, fruits, lean protein, nuts and seeds and eliminating refined foods. Be very cautious about products sold in Chinatown as they may be adulterated with pharmaceuticals. Products sold in health food stores may contain the proverbial “kitchen sink” of glucose nutrients, yet not enough of any one ingredient to get a therapeutic effect.