Controlling Diabetes

Natural Ingredients Can Help Rein in Risk Factors

Several forms of diabetes have been identified, with type 1 and type 2 being the most common. Type 1 diabetes, also known as insulindependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5 to 10 percent of all diagnosed cases of diabetes and usually affects children and young adults, according to the Centers for Disease Control and Prevention (CDC). Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, which are the only cells in the body that can make the hormone insulin to regulate blood glucose levels. In order to survive, type 1 diabetics have to inject regular doses of insulin. There is currently no cure for type 1 diabetes and risk factors for the disease are autoimmune, genetic or environmental.

The more prevalent form of diabetes is type 2, which constitutes 90 to 95 percent of all diagnosed cases of diabetes. Type 2 has also been called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. This form stems from the body’s inability to properly use insulin. And as the body needs more insulin, the pancreas starts to lose its ability to produce the hormone. Type 2 risk factors include old age, physical inactivity, obesity and race/ethnicity.

One major risk factor of type 2 diabetes is obesity. And it’s no surprise that there has been a dramatic rise in diabetes as waist lines in the United States continue to expand. As of 2005, there were nearly 21 million people with diabetes, according to the CDC, and an estimated 65 percent of Americans are overweight or obese. Obesity and high blood pressure are wellknown precursors to diabetes and cardiovascular disease. To better characterize these risks, doctors have identified something called the metabolic syndrome, which identifies this cluster of risk factors—increased blood pressure, elevated insulin levels, excess body fat, and abnormal cholesterol— that can lead directly to heart disease, stroke and diabetes. In essence, the unfortunate end results—heart disease, stroke, kidney failure, nerve damage and amputations—of metabolic syndrome could be avoided if blood pressure and weight could be controlled. Therefore, in order to avoid the ill effects of diabetes and their subsequent costs on the health care system, patients and health care professionals are focusing on alternative treatments that could help alleviate the risks and complications associated with type 2 diabetes.

The amount of fiber a person has in his or her diet can affect a person’s susceptibility to type 2 diabetes. In a study published in the Journal of the American College of Nutrition, researchers looked back on 25 years of studies and recommendations.1 They found that a high-carbohydrate, high-fiber diet can improve blood glucose and glycated hemoglobin (A1C) levels, which measure long-term blood glucose control. The authors also said such a diet can improve lipid (fat) levels in the blood. Based on the past research, they made the recommendation that people should eat 25 to 50 g/d of fiber.

In addition, researchers at the Harvard School of Public Health found that cereal fiber intake decreased the risk of type 2 diabetes.2 The eight-year study looked at the association between dietary fiber intake, glycemic index and the risk of type 2 diabetes development in approximately 90,000 women. The researchers also found that the glycemic index was significantly associated with an increased risk of type 2 diabetes. The National Public Health Institute of Helsinki, Finland, found similar results in a 10-year follow-study of more than 4,200 adults.3 The researchers concluded a higher intake of whole grain and cereal fiber significantly reduced the risk of type 2 diabetes development.

A recent study in Diabetes Care found that a three-day diet with insoluble dietary fiber improved insulin sensitivity in the 17 overweight or obese women who ate either a placebo of white bread or fiberenriched white bread.4 Similarly, a four-year follow-up study of 36,787 people between the ages of 40 and 69 years old found that reducing dietary glycemic index while including more carbohydrates in the diet could reduce the risk of type 2 diabetes.5 The researchers said one way to do this is to substitute white bread with low-GI breads.

Oats can help diabetics control blood glucose and cardiovascular problems. They contain a type of soluble fiber called beta-glucan that can also help lower cholesterol. The American Diabetes Association describes oats as “nature’s broom”, literally whisking excess cholesterol out of the system.

Researchers from the University of Kuopio in Finland looked at the post-meal glycemic response of type 2 diabetics eating two different oat bran products—oat bran flour (as Natureal, from GTC Nutrition) and oat bran crisp.6 Twelve volunteers were randomly given the oat bran flour, oat bran crisp and a glucose load providing 12.5 g of a glycemic carbohydrate, 25 g of a glucose load alone and 25 g of a glucose load with 30 g of oat bran flour. After five two-hour post-meal glucose tolerance tests, the results showed that oat bran flour high in beta-glucan had a low glycemic response and also decreased the post-meal glycemic response of an oral glucose load in type 2 diabetics.

Canadian researchers also looked into the long-term effects of oat bran products on glycemic response.7 In the 24-week study, noninsulin dependent diabetes patients were given either a high-fiber oat bran concentrate bread product with beta-glucan or a control of white bread. After analyzing blood glucose, insulin and lipid levels, the study concluded the oat-bran concentrated products helped control all three of these parameters. Other studies have shown a hypocaloric diet containing oats can significantly decrease cholesterol and blood pressure when compared to a similar diet that does not include oats.8

The mineral chromium is one of the best studied minerals in the area of diabetes as it has been shown to control blood glucose levels; however, studies have indicated chromium’s effectiveness in controlling or preventing type 2 diabetes might be a factor of ethnicity and diet. Chromium can be found in various foods, including whole-grain cereals, prunes, nuts and seafood. According to a study in Diabetes & Metabolism, chromium helps insulin bind to cells and increases the number of insulin receptors and insulin sensitivity.9 The study suggests that low chromium levels in one’s diet can increase the risk of cardiovascular diseases as well as type 1 and 2 diabetes.

A study out of the University of Vermont evaluated 37 people with type 2 diabetes in randomized, double blind fashion and found supplementation with chromium picolinate with sulfonyurea agents significantly improves glucose control and insulin sensitivity.10 In addition, the researchers found chromium supplementation helped reduce weight gain and visceral fat accumulation when compared to the placebo group. Bulgarian scientists also found chromium supplementation early in the therapy of type 2 diabetes can help reduce the degree of insulin resistance.11

A 12-week study of 50 type 2 diabetics and 50 non-diabetics in India was conducted to determine the role chromium has in insulin resistance.12 The researchers concluded chromium supplementation can improve the glycemic control of type 2 diabetics possibly due to an increase in insulin action rather than stimulation of insulin secretion. Researchers, however, said chromium levels appeared to be higher in the general Indian population when compared to many Western countries.

The idea of ethnic differences and the effectiveness of chromium in type 2 diabetics was also seen in a recent Diabetes Care study.13 These researchers wanted to investigate whether chromium helped obese Europeans who took insulin to treat their diabetes. Over the course of six months of the double blind study, patients were randomly assigned to receive a placebo or 500 or 1,000 mcg/d of chromium. At the end of the study, the decrease in the A1C levels in each group was about the same (0.4 percent). Therefore, the researchers concluded that there is no evidence that high-dose chromium treatment is effective in Western type 2 diabetics. The results of this study contradict many of the Asian-based studies, which often point to a benefit of chromium in type 2 diabetes patients. The authors of the Diabetes Care study said the difference could be that Western diets naturally contain more chromium or that the Asian counterparts are not as obese as the Western patients. Therefore, the authors added, the results of their study might not apply to lean people with type 2 diabetes, people who don’t require insulin to treat their diabetes, or people of different ethnicities.

Past studies have linked magnesium deficiency to increased risk of type 2 diabetes, but more recent studies are beginning to show that a magnesium-rich diet could actually reduce the risk of developing the disease. Harvard researchers followed 85,060 women and 42,872 men who had no history of diabetes, cardiovascular disease or cancer at baseline.14 Magnesium intake was evaluated using questionnaire every two to four years. After 18 years, 4,085 women developed type 2 diabetes; after 12 years, 1,333 men had developed the disease. After taking into account various diabetes risk factors—such as age, weight, smoking and family history—researchers found that people with a diet high in magnesium had a significantly lower risk of developing type 2 diabetes compared to those with lower magnesium levels. Northwestern University researchers recently published a similar study that went one step further and looked at magnesium’s preventive benefits in younger people.15 The study followed 4,637 people between the ages of 18 and 30. At the end of 15 years, 608 people developed metabolic syndrome; after looking at magnesium intake among the subjects, the researchers concluded young adults who consume a diet high in magnesium have a lower risk of developing metabolic syndrome.

Most studies have investigated magnesium-rich diets that include bran cereal, spinach and almonds; therefore, researchers at the Brigham and Women’s Hospital and Harvard Medical School examined the effects of magnesium supplementation and glycemic control in type 2 diabetics.16 They reviewed nine randomized, double blind, controlled trials of 370 type 2 diabetics. The median dose between all the studies was 360 mg/d, and the researchers concluded oral magnesium supplementation for 4 to 16 weeks might be help reduce plasma fasting glucose levels in type 2 diabetics while also raising HDL cholesterol. However, they said the long-term safety and benefit of magnesium supplementation still needs to be determined.

The metal vanadium has shown insulin-like properties, which has piqued the interests of researchers. Canadian researchers said vanadium has been shown to enhance glucose transport, glycogen and lipid synthesis, and inhibits gluconeogenesis and lipolysis in isolated cells.17 On the molecular level, the metal’s effects have been shown to activate several key insulin-signaling pathways. A study out of the Albert Einstein College of Medicine compared oral vanadyl sulfate, which is a salt of vanadium, in type 2 diabetics and nondiabetics.18 They found oral supplementation did not have an effect on insulin sensitivity in the nondiabetic group. However, vanadyl sulfate did improve hepatic and skeletal muscle insulin sensitivity in the type 2 diabetics studied. The researchers said this could be a result of the supplement’s ability to enhance insulin’s inhibitory effect on lipolysis, which is the breakdown of fat in fat cells.

Vanadium is essential in many biological processes; however, based on its metallic properties, researchers fear too much vanadium could be toxic.19 Toxic side effects of inorganic vanadium could include gastrointestinal discomfort and decreased body weight gain. Vanadium salts have also been shown to have potential toxic effects on the liver and kidney. However, organic vanadium has been shown to be safer and does not display the same toxic side effects as the inorganic version.20

Antioxidant nutrients have been studied for their possible benefit in the health of type 2 diabetics. Australian scientists found supplementation with coenzyme Q10 (CoQ10) might improve blood pressure and long-term glycemic control in patients with type 2 diabetes.21 In the study, 74 type 2 diabetics who had dyslipidemia were randomly assigned either an oral dose of 100 mg CoQ10 twice daily, 200 mg/d fenofibrate (a lipid regulating agent), both or neither for 12 weeks. Fenofibrate alone did not alter blood pressure, but CoQ10 significantly decreased systolic and diastolic blood pressure. Another study out of Australia found that CoQ10 helped dilate the brachial artery of dyslipidemic type 2 diabetics.22 Researchers concluded CoQ10 supplementation in this group of patients improves the endothelial function of conduit arteries in peripheral circulation.

Another potentially beneficial antioxidant for diabetics is alphalipoic acid (ALA). Research has found ALA stimulates the signaling of insulin, which increases glucose uptake in muscle and fat cells.23 It can also protect the body from oxidative stress-induced insulin resistance. Such factors make an attractive treatment for insulin resistance. It might also be helpful in slowing down the effects of a peripheral nerve disorder called diabetic neuropathy. Researchers from the Russian Medical Academy in Moscow used the Total Symptom Score (TSS) to assess the safety and efficacy ALA had in improving nerve function in diabetics. Type 2 diabetics were randomized into groups that received either 600 mg of ALA daily or a placebo for five days a week over the course of 14 treatments.24 After the treatments, the ALA group improved their TSS scores by an average of 5.7 points while the placebo improved by an average of 1.8 points. The TSS score is a measure of positive neuropathic symptoms. The findings led the researchers to conclude ALA could be a useful ancillary treatment for the symptoms of diabetic polyneuropathy because of its safety profile as well as its positive TSS results.

A prospective, open and non-randomized study followed 84 patients with diabetes mellitus to evaluate the benefits of ALA.25 Forty-nine patients served as the control group and did not receive ALA; 35 patients were treated with 600 mg/d of ALA. To assess ALA’s effect on endothelial cell damage and diabetic nephropathy, the researchers measured plasma thrombomodulin (PT) and urinary albumin concentration (UAC). After an 18-month follow-up, the control group’s PT levels increased while the PT level in the ALA group decreased. The UAC increased in the control group and remain unchanged in the ALA group. The researchers concluded that oxidative stress could have a large role in diabetic nephropathy and that the disease could be slowed down by antioxidants. They noted, however, that a placebo-controlled study is needed.

The Southeastern Asian herb banaba is also being used to control the glucose levels of type 2 diabetics. In a proprietary, randomized, double blind study, 12 type 2 diabetics were given a 1-percent corosolic acid concentration of banaba (as GlucoFit™, from OptiPure) at sequential doses of 16, 32 and 48 mg for 15-day periods, with a 10-day washout period between doses. During the study, subjects did not take oral hypoglycemic medication for an average of 45 days preceding baseline and maintained their normal diet throughout the study. Diabetics who took the banaba showed a significant drop in blood glucose levels at a 48 mg dose.

European researchers concluded cinnamon extract seems to have a moderate effect in reducing plasma glucose concentrations in type 2 diabetics.29 In the double blind study, 79 type 2 diabetics not on insulin therapy were randomly assigned a 3 g cinnamon extract or placebo capsule to take three times a day for four months. Fasting plasma glucose levels were significantly different between the two groups as the cinnamon group saw a reduction of 10.3 percent and the placebo group’s levels dropped 3.4 percent.

Some researchers contend more research needs to be performed before health claims about cinnamon’s benefits can be made. For example, researchers from Maastricht University in the Netherlands investigated the effect of cinnamon supplementation in 25 postmenopausal type 2 diabetics.30 During the six-week study, subjects took either 1.5 g/d of cinnamon or a placebo. After analyzing bloodwork, the researchers concluded the 1.5 g dose of cinnamon did not improve whole-body insulin sensitivity or oral glucose tolerance in the subjects studied.

Americans are no strangers to coffee in the morning. And researchers have been able to demonstrate a link between caffeine and a reduced risk of developing type 2 diabetes.31 However, Japanese researchers took this one step further and looked at the effects green tea consumption had on the risk of type 2 diabetes.32 The study started with 17,413 people who had no history of diabetes, cardiovascular disease or cancer. Over the course of the study, researchers had the subjects fill out questionnaires about their consumption of coffee; black, green and oolong teas; and physiciandiagnosed diabetes. After a five-year follow-up, 444 people developed diabetes, and researchers found frequent consumption of coffee and green tea reduced the risk of developing type 2 diabetes.

Researchers at the Mahidol University of Bangkok, Thailand, found oral aloe supplementation had a beneficial effect on blood sugar, cholesterol and triglycerides.34 They performed a placebocontrolled, single blind clinical trial that followed 72 human subjects with high fasting blood sugar and a typical diabetic curve of glucose tolerance, who had never been treated with hypoglycemic drugs. The treatment group received 15 mL of aloe gel twice daily or 42 days. Weekly blood samples measured fasting blood glucose levels and biweekly samples measured triglyceride and cholesterol. There was no significant difference in blood markers between the groups before the treatment. However, after the treatment, blood sugar in the treatment group fell 43 percent and blood triglycerides lowered 44 percent.

Several studies have shown different species of gymnema to benefit insulin function and glucose control. Gymnema montanum was shown in animal research to reduce blood glucose levels and increase plasma insulin levels.36 The same gymnema species was shown in additional research to have antioxidant properties, as well as antihyperglycemia effects.37 Gymnema yunnanense was shown to lower fasting glucose and improve glucose tolerance in obese mice, as well as decrease fasting blood glucose levels in diabetic mice.38

An extract from French maritime pine bark has drawn the attention of researchers for its potential to control blood sugar levels in type 2 diabetics. After conducting a double blind, placebocontrolled, randomized multicenter study in which 77 type 2 diabetics took 100 mg/d of pine bark extract (as Pycnogenol®, from Natural Health Science) for 12 weeks, Chinese researchers concluded that this French maritime pine bark can help type 2 diabetics lower glucose levels and improve endothelial function.43

Italian researchers also studied Pycnogenol and determined it might have a beneficial effect of diabetic nephropathy and other vascular retinal disorders.44 A total of 40 patients with diabetes received either a placebo or 50 g Pycnogenol three times a day. After two months, diabetics in the placebo group had a gradual progression of retinopathy and a significant decline in visual acuity. Patients in the Pycnogenol group had no retinal deterioration and significantly recovered visual acuity. The researchers said this might be because of the pine bark extract’s free-radical scavenging, antiinflammatory and capillary protective activities. They even suggested Pycnogenol might bind the blood vessel wall proteins and mucopolysaccharides and produce a capillary sealing effect leading to reduced capillary permeability and edema formation.

Pycnogenol was also investigated for its possible benefits in treating diabetic ulcers, which are common in the feet of diabetics. Thirty patients were divided into four groups and given one of four ulcer treatments, which included systemic Pycnogenol and local application, local Pycnogenol only, oral Pycnogenol, and medications only.45 After six weeks, the combined treatment healed 89 percent of the ulcers, the local treatment healed 84 percent, 85 percent with the oral treatment, and 61 percent with only the medications.

With continued concern in the United States about obesity and its related health concerns—diabetes and metabolic syndrome in particular—it is certain that health care professionals will be seeking out auxiliary treatments even as consumers learn more about natural ingredients that may support their health over the long term.

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