Diabetes

Diabetes

by Kim Schoenhals

All energy on earth is sustained by the sun, and people take in this energy by consuming various foods. Plants absorb energy from sunlight through photosynthesis, animals eat plants, and humans eat the plants and animals, effectively consuming the suns energy. Regardless of the type of food ingested, the body breaks it down into glucose, a simple sugar that is the primary source of cellular energy. However, the cells cant take up glucose without assistance from insulin.

Insulin is a hormone produced by the pancreas, and its primary purpose is to help transport glucose from the blood into cells so it can be burned for energy. When this process malfunctions, it is called insulin resistance. When the pancreas does not make enough insulin or the body is unable to use the insulin that is present, the cells cannot use glucose, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (www.niddk.nih.gov). Excess glucose builds up in the bloodstream, setting the stage for diabetes.

Pre-diabetes (sometimes called impaired fasting glucose or impaired glucose tolerance) is when blood glucose is above normal levels but has not reached diabetic levels. In pre-diabetes and insulin resistance, insulin levels and blood glucose levels are often elevated. If you have insulin resistance, your muscle, fat and liver cells do not use insulin properly, according to NIDDK. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the bodys need for insulin, and excess glucose builds up in the bloodstream.

NIDDK noted approximately 16 million Americans have pre-diabetes, and most are unaware of it. Pre-diabetes increases the risk for developing Type II diabetes (formerly known as non-insulin-dependent diabetes), which develops in cases when the body fails to respond properly to insulin. Excess body weight is also a key factor in pre-diabetes, because it contributes to insulin resistancefat and lack of exercise can hinder the muscles ability to use insulin.

In the case of pre-diabetes, physicians will usually prescribe dietary and lifestyle changes. The main goal of addressing pre-diabetic conditions is to retrain the body to utilize insulin correctly. Losing weight and becoming more active can reduce the risk of diabetes by up to 58 percent, according to NIDDK, and can help people with pre-diabetes attain normal blood glucose levels. In terms of diet, following a low-fat, low-calorie regimen helps insulin function by assisting in weight loss and lowering blood pressure and cholesterol.

As with pre-diabetes, the metabolic syndrome is associated with an increased risk of heart disease. Another risk factor for Type II diabetes, the metabolic syndrome (otherwise known as Syndrome X) is characterized by high blood glucose, excess abdominal fat, high LDL cholesterol and triglycerides, low HDL cholesterol, and high blood pressure.

Heart disease is also a major complication of diabetes itself. NIDDK statistics show those with diabetes are two to four times more likely to die from heart disease or stroke than those without the disease, and about 73 percent of adults with diabetes have high blood pressure. Diabetes is also the leading cause of blindness among adults ages 20 to 74 years, and is the leading cause of end-stage renal disease.

The number of Americans with diabetes in 2003 was approximately 18.2 million people, according to Health and Human Services Secretary Tommy G. Thompson. These new estimates show we are diagnosing more people who live with diabetes, and the overall prevalence of this disease continues to increase, he said. Clearly, diabetes remains a serious and growing health threat. We are fighting this terrible disease by promoting better lifestyle choices and increasing awareness among all Americans.

The push behind improving lifestyles is to regulate blood glucose levels, which can slow down or prevent the complications of diabetes, according to NIDDK. Natural products may be added to a treatment regimen as part of dietary and lifestyle changes. Several ingredients in the natural products industry are believed to assist in reducing the risk of diabetes-related degenerative disease, as well as improving insulin function and maintaining healthy blood glucose levels. Minerals, vitamins, botanicals and specialty ingredients all have specific roles in protecting against diabetes development, or helping maintain blood glucose levels if the disease is already present.

Minerals

Of the natural products used in addressing impaired insulin function and high blood sugar, the mineral chromium is probably one of the more well-known supplements. In fact, chromium use is known to be higher among diabetics than the general population, according to the Natural Marketing Institutes (NMI) Health and Wellness Trends Database. NMI noted that 4.7 percent of the general population use supplements with chromium, and 5.8 percent of diabetics do the same.

Chromium is necessary for proper insulin function and blood glucose regulation because it helps facilitate the uptake of glucose for energy production. It is also known to increase the efficacy of insulin, thereby reducing the amounts the body needs to produce. Researchers at Mercer University in Atlanta noted trivalent chromium (as opposed to hexavalent chromium, which is toxic to humans) is an essential nutrient for glucose metabolism and may reduce glucose levels in hyperglycemia.¹ They added chromium appears to be safe and may have a role as an adjunctive treatment in Type II diabetes.

Chromium supplementation may be able to reverse diabetes development, according to research presented at the 2nd International Congress on Nutrition and Aging. The studys authors, from the Beltsville Human Nutrition Research Center, discussed a study of more than 40,000 people that showed chromium supplementation improved insulin sensitivity in overweight subjects and had a dose-dependent effect on glucose, insulin and insulin sensitivity.

Additional promising results in diabetes were found through animal research that utilized chromium picolinate.² Indian researchers concluded chronic chromium picolinate administration improved glucose tolerance, as well as renal and hepatic function, indicating a possible role in the long-term management of diabetes. Human research of chromium picolinate showed that of 50 Type II diabetics, those taking the mineral (as Chromaxchromium picolinate, from Purchase, N.Y.-based Nutrition 21) exhibited significant improvements in glycemic control and serum fasting insulin compared to the control group.³

Research presented at the American Diabetes Associations 63rd Scientific Sessions, held June 2003 in New Orleans, also demonstrated positive results from supplementation with chromium picolinate (as Chromax). Researchers from the University of Vermont Medical College, Burlington, presented one study that showed chromium picolinate enhanced carbohydrate metabolism and glucose control by apparently down-regulating TNF-alpha and ubiquitin proteins, which are involved in carbohydrate metabolism. A second study presented by the same researchers indicated chromium picolinate combined with conjugated linoleic acid (CLA) increased muscle glycogen levels, indicating an increase in the bodys ability to process stored glucose.

Another form of trivalent chromium, niacin-bound chromium (a.k.a. chromium nicotinate, chromium polynicotinate), also has been shown to improve the health of diabetic patients. In addition, the nutrient may affect body composition, which is a well-known risk factor for the development of diabetes. In a pilot study, 20 overweight women were put on an exercise regimen and given either placebo or niacin-bound chromium (as ChromeMatefrom Benicia, Calif.-based InterHealth Nutraceuticals).⁴ After two months, the women taking chromium lost significantly more fat and maintained more muscle than women in the placebo group.

Chromium nicotinate may also reduce the risk of heart disease in diabetic patients, more so than exercise alone, according to a review conducted by researchers at the University of Texas, Austin.⁵ Animal research has also shown chromium polynicotinate (as ChromeMate) has beneficial effects on heart health when used in combination with two other ingredientsgrapeseed extract and zinc monomethionine (as OptiZincfrom InterHealth).⁶ The combination was shown to lower systolic blood pressure and decrease oxidative damage to lipids, as well as act in an antioxidant capacity and sensitize insulin response.

The antioxidant mineral zinc has also been investigated separately in diabetes. Orally administered zinc (as zinc acexamate but not zinc sulfate) restored healthy serum glucose, triglyceride and serum zinc levels, as well as other indicators in diabetes-induced rats, including bone loss.⁷ In diabetic humans, zinc (as zinc gluconate) decreased oxidative stress after six months, which researchers noted is beneficial because of the negative effects oxidative damage can have on diabetics.⁸

Additional research compared zinc and selenium for their effects in diabetic populations because, as antioxidants, the two minerals could reduce the risk of vascular degeneration that occurs due to hyperglycemia-induced oxidative stress.⁹ A review of recent literature showed zinc modulates insulin activity, at least in part, via its antioxidant capacity, and zinc status is decreased in most Type II diabetic patients. In addition, the review showed low selenium activity is common in diabetic patients, and is associated with thrombosis and cardiovascular complications.

Individually, selenium is known to correct oxidative stress and improve lipid metabolism in Type II diabetes, as demonstrated by a Russian clinical trial.¹⁰ Because of its antioxidant properties, selenium may protect against diabetes-induced testicular complications, thereby maintaining fertility, according to animal research out of Firat University in Turkey.¹¹ Seleniums antioxidant capacity, when combined with the antioxidant properties of vitamin E, also seems to be of potential therapeutic value against diabetic retinopathy, according to a study at Catholic University in Rome.¹²

As with zinc and selenium, magnesium levels are known to be lower in Type II diabetics than in healthy controls, and magnesium depletion may negatively affect glucose levels and insulin sensitivity.^13,14 According to research out of Switzerland, animal studies have suggested diabetes impairs magnesium absorption, but dietary magnesium absorption and retention are not impaired in humans with reasonably well-controlled Type II diabetes.¹⁵

Image: Diabetes Managers' Daily Use of Supplements is Slightly Lower than GP for All Listed Except Chromium

Animal research investigating magnesium supplementation for diabetes showed the mineral restored magnesium status to near normal levels with a marginal but significant decrease in blood glucose levels.¹⁶ The study also showed magnesium supplementation increased antioxidant enzyme activity and decreased oxidative stress in an experimental animal model of Type II diabetes. A human study conducted in New Delhi showed patients with Type II diabetes who were given daily magnesium (as magnesium oxide) for 12 weeks exhibited a reduction in serum total and LDL cholesterol, decreased triglycerides and increased HDL cholesterol.¹⁷ The human study did not show an impact of magnesium supplementation on blood glucose levels.

Vitamins & Vitamin-Like Compounds

A combination of micronutrientsminerals and vitamins alikeis believed by many to be part of a healthy lifestyle. Research has shown taking multis can improve human health, particularly in elderly subjects with Type II diabetes.²¹ Of 130 community-dwelling adults, those taking multivitamin and mineral supplements reported fewer diabetes-related infections over the study year than those taking placebo. Moreover, among diabetic participants receiving placebo, 93 percent reported an infection compared to 17 percent taking multis. Another study of multivitamin and mineral supplementation showed supplements reduced the risk of birth defects in the offspring of mothers with diabetes.²²

Interestingly, an additional analysis of NHANES III conducted by researchers at the Centers for Disease Control and Prevention (CDC) showed participants with the metabolic syndrome had significantly lower antioxidant concentrationsspecifically of vitamin C, vitamin E and carotenoids, except for lycopene.²⁵ Additional research showed vitamin A and vitamin E concentrations, but not vitamin C concentrations, were significantly lower in diabetic subjects compared to healthy controls.²⁶ And, short-term treatment with high doses of vitamin C (2 g/d) improved the health of diabetic patients who also had coronary artery disease.²⁷

Antioxidant treatment with vitamin E also appears to have beneficial effects against diabetes complications. Researchers in Shiga, Japan, found vitamin E supplementation normalized renal function and hypertension in an animal model of Type II diabetes, leading to the conclusion that oxidative stress plays a crucial role in the development and progression of diabetic nephropathy, and antioxidant treatment may be therapeutic.²⁸ Additional animal research out of Sweden showed treatment with alpha-tocopherol prevented diabetes-induced disturbances in oxidative stress and protected kidney function in diabetic rats.²⁹ Another animal study, which investigated the effects of a tocotrienol-rich diet, indicated the treatment significantly lowered blood glucose compared to control animals.³⁰ A human trial involving 39 subjects indicated natural vitamin E taken daily for four months protected against diabetic nephropathy.³¹

CoQ10 may also improve diabetics health by improving heart health. A human trial of 74 subjects with uncomplicated Type II diabetes indicated CoQ10 supplementation for 12 weeks decreased systolic and diastolic blood pressure, and it may also have long-term effects on glycemic control.³⁴ Another 12-week human clinical trial showed CoQ10 supplementation improved glycemic control, as well as protected heart health by improving endothelial function in subjects with Type II diabetes and dyslipidemia.³⁵

Another vitamin-like compound that possesses antioxidant properties and may improve diabetes by affecting mitochondrial function is alpha-lipoic acid (ALA). Animal research conducted at the University of Montreal showed ALA administration prevented glucoserelated increases in heart mitochondrial superoxide production that was seen in non-supplemented rats.³⁶ ALA also prevented increases in blood pressure, insulin resistance and glucose levels that were seen in control rats. Researchers concluded the sulfur-containing compound prevented hypertension and hyperglycemia, presumably through antioxidant properties.

Animal research into the antioxidant benefits of ALA in diabetes showed the compound elevated glutathione peroxidase activity in the kidney, normalized superoxide dismutase activity in the heart and reduced overall oxidative stress in diabetic rats.³⁷ Additional research showed eight weeks of ALA treatment had a therapeutic effect against gastrointestinal autonomic neuropathy (a chronic pain condition).³⁸

A research review cited ALA as one of the more popular supplements for use against diabetic neuropathy.³⁹ A human trial of intravenously administered ALA supported the use of the compound against diabetes-related neuropathy, including reduced pain and other neuropathic endpoints, compared to placebo.⁴⁰

Botanicals

The plant world comprises countless components that have therapeutic value in human health, including glucose control and insulin function. A research review of 58 clinical trials involving subjects with diabetes or impaired glucose tolerance indicated positive effects on glucose control in just over three-quarters (76 percent) of the studies.⁴¹ Researchers from Harvard Medical School concluded while there is still insufficient evidence to derive definite conclusions about the use of herbals and dietary supplements in diabetes, they appear to be generally safe.

One botanical the researchers mentioned for having positive preliminary support is gymnema (Gymnema sylvestre). 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.⁴² The same gymnema species was shown in additional research to have antioxidant properties, as well as antihyperglycemia effects.⁴³Gymnema 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.⁴⁴

A research review of Indian plants with anti-diabetic potential mentioned Gymnema sylvestre and fenugreek (Trigonella foenum graecum) as two of the most popularly studied plants for diabetes and its complications.⁴⁵ Researchers from the All India Institute of Medical Sciences in New Delhi evaluated the efficacy of several plants, including fenugreek, which they noted possessed hypoglycemic and antihyperglycemic activity.

Other researchers in India showed fenugreek decreased blood glucose levels by 14.4 percent after 15 days and by 46.6 percent after 30 days, as well as decreased diabetes-related alterations in glycogen.⁴⁶ In a trial of 25 newly diagnosed Type II diabetics, fenugreek was shown to improve glycemic control and decrease insulin resistance.⁴⁷ Also of importance in diabetes, fenugreek improves heart health by lowering triglycerides, LDL and total cholesterol, and raising HDL cholesterol.⁴⁸ Fenugreek is also known to restore antioxidant balance in diabetics.⁴⁹

Researchers at the Hebrew University of Jerusalem noted fenugreek and its isolated fractions act as hypoglycemic and hypocholesterolemic agents in both human and animal studies.⁵⁰ One fenugreek fraction, an amino acid called 4-hydroxyisoleucine (4-OH-Ile), was shown to restore glucose-induced insulin response after an acute, intravenous dose in an animal model of Type II diabetes.⁵¹ After six days of administration, the amino acid reduced hyperglycemia and insulinemia, and improved glucose tolerance. The French researchers also conducted an in vitro experiment and determined the amino acid potentiated glucose-induced insulin response, indicating 4-OH-Ile acts by stimulating pancreatic beta cells.

Additional unpublished in vitro research out of the University of Montana showed 4-OH-Ile (as Promilin, supplied by Technical Sourcing International Inc.) stimulated insulin secretion across a wide range of concentrations. Company-sponsored pilot studies have shown Promilin reduces glucose concentrations without affecting insulin levels in non-diabetic subjects, indicating it may enhance natural metabolic sensitivity.

Another fraction of fenugreek that has been studied for regulating glucose levels is fenugreek galactomannan. In one unpublished study, 10 healthy subjects given different singular doses of a standardized fenugreek galactomannan extract (as FenuLife, supplied by Minneapolis-based Acatris Inc.) exhibited a lowered glycemic response, with an 8 g dose being the most effective, compared to 1 g, 2 g or 4 g doses. Another study involved Type II diabetic subjects who took 4 g/d of FenuLife for eight weeks.⁵² Subjects in the treatment group exhibited reduced fasting blood sugar levels compared to placebo. Another group of subjects given 4 g/d of fenugreek galactomannan for the first four weeksat which point blood sugar levels were reducedwere put on a reduced dose of the extract (2 g/d) for the following four weeks, with the lower dose maintaining improved serum glucose levels.

In vitro research out of the College of Osteopathic Medicine in Athens, Ohio, demonstrated the botanical Lagerstroemia speciosa L. (banaba) stimulates glucose uptake in a time- and dose-dependent manner similar to insulin, leading researchers to conclude it may prevent and treat hyperglycemia and obesity in Type II diabetics.⁵³ Additional research with the botanical in mice showed banaba almost entirely suppressed a glucose-stimulated elevation of blood glucose and lowered plasma total cholesterol.⁵⁴

Specialty Ingredients

In addition to the botanical ingredients, several specialty ingredients are known to affect the symptoms of diabetes. Maitake mushroom was found in animal research to reduce initial fasting and maximum blood glucose levels, as well as increase insulin concentrations in diabetic rats, leading researchers to conclude the bioactive substances present in Maitake can ameliorate the symptoms of diabetes.⁵⁶ One fraction of Maitake, a glycoprotein (an oligosaccharide-bound protein) called SX-Fraction(supplied by Paramus, N.J.-based Maitake Products Inc.), is known to possess hypoglycemic activity, as well as an ability to improve blood glucose, insulin and triglyceride levels, according to a research review out of New York Medical College, Valhallah.⁵⁷ Animal research suggested Maitake SX-Fraction given twice daily instead of once daily may sustain or prolong the glucose-lowering effect.⁵⁸ When administered in combination with two additional novel ingredientsniacin-bound chromium (as ChromeMate) and (-)-hydroxycitric acid from Garcinia cambogia (as CitriMaxfrom InterHealth Nutraceuticals)Maitake SXFraction can improve the symptoms of the metabolic syndrome, including blood pressure, body weight, insulin resistance and glucose concentrations.⁵⁹

Like Maitake, oats contain polysaccharide components called betaglucans. Researchers at St. Michaels Hospital in Toronto concluded from their human clinical trial that oat beta-glucans are a useful functional food ingredient for reducing postprandial glycemia.⁶⁰ In the study, diabetic subjects were randomly assigned to eat a prototype beta-glucan cereal bar, a commercial oat bran breakfast cereal or white bread. The beta-glucan bar had a significantly lower glycemic index than the other two treatments, leading researchers to conclude the addition of beta-glucan predictably reduced glycemic index while maintaining palatability. In additional research, an unpublished animal study showed oat beta-glucans (as Nutrim Oat Bran, manufactured by Momence, Ill.-based FutureCeuticals) reduced blood glucose levels, slowed body weight gain and lowered serum triglycerides.

Several other specialty ingredients have promising evidence supporting their use against diabetes symptoms. Preliminary results from an unpublished human study indicated patients taking a concentrated extract from the white kidney bean (as Phase 2, distributed by Pharmachem Laboratories in Kearny, N.J.) had significantly improved blood glucose levels and insulin production, as well as lowered triglycerides. Like the white kidney bean, an extract from the soybean may also affect cholesterol in diabetic subjects, as demonstrated by unpublished research released by Ashdod, Israelbased Solbar Plant Extracts. The trial of 32 postmenopausal women with diet-controlled Type II diabetes showed 132 mg/d of soy isoflavones significantly lowered total cholesterol, as well as fasting insulin and insulin resistance after 12 weeks. Insulin resistance can also be decreased by taking a protein and amino acid mixture with carbohydrate intake, according to researchers at Maastricht University in The Netherlands.⁶²

Numerous antioxidant compounds are also believed to affect parameters of diabetes and insulin function. Research using nondiabetic subjects showed dietary carotenoid intake can beneficially affect glucose metabolism in men who are at high risk of developing Type II diabetes.⁶³ Additional research showed fruits and vegetables high in carotenoids may protect against hyperglycemia,⁶⁴ and another study showed plasma concentrations of lutein and beta-carotene were inversely related to maintaining plasma glucose concentrations in healthy volunteers.⁶⁵ Another carotenoid, astaxanthin, can decrease non-fasting blood glucose levels, as demonstrated by an animal model of Type II diabetes.⁶⁶

While carotenoids are fat-soluble pigments found in plants, flavonoids are water-soluble plant pigments. Some of these antioxidant compounds have also shown promise in the realm of diabetes treatment. Grapeseed extract (as ActiVin, the patent for which is owned by San Joaquin Valley Concentrates in Fresno, Calif.), which contains a group of flavonoids called proanthocyanidins, improves insulin sensitivity and reduces free radical formation when taken in combination with niacin-bound chromium (as ChromeMate).⁶⁷ And, the flavonoid quercetin is recognized for its ability to inhibit the development of diabetic cataracts.⁶⁸

Another antioxidant, French maritime pine bark, is known for its effects in preventing diabetes-related eye degeneration. A research review of studies involving Pycnogenol(available from Hillside, N.J.- based Natural Health Science) showed the extract improved capillary resistance and reduced leakage into the retina, thereby inducing a favorable outcome in the majority of patients with diabetic retinopathy.⁶⁹ A double blind trial of 40 patients with diabetes, atherosclerosis and other vascular diseases of the retina showed Pycnogenol supplementation slowed the progression of retinopathy and significantly improved visual acuity by producing a sealing effect on capillaries.⁷⁰ Another study of the extract showed it significantly reduced blood glucose concentrations and increased endogenous antioxidant defenses in diabetic rats.⁷¹

Antioxidant status may be restored to normal ranges in various tissues by taking omega-3 and omega-6 fatty acids. Researchers from EFA Sciences LLC in Norwood, Mass., reported in one study that omega-3 fatty acidseicosapentaenoic acid and docosahexaenoic acidas well as alpha-linoleic acid can prevent chemically induced diabetes and attenuate oxidant stress in experimental animals.⁷² In another study, the same researchers found the omega-6 fatty acids gamma-linolenic acid and arachidonic acidalso restored antioxidant status and prevented chemically induced diabetes in test animals.⁷³

Fish oil, known to contain omega-3s, has also been studied for its effects in diabetes. In a group of Type II diabetics, fish oil supplementation was shown to reduce triacylglycerol (a predominance of which may lead to high cholesterol levels) and increase HDL cholesterol.⁷⁴ However, animal research showed fish oil supplementation may not influence insulin sensitivity,⁷⁵ and a human trial showed it did not influence glycemic control or fasting blood glucose.⁷⁶

While its effects on insulin and glucose are debated, fish and longchain omega-3 fatty acid consumption has been linked to a reduced risk of coronary heart disease occurrence and mortality in diabetic women.⁷⁷ Researchers analyzed data from 5,103 nurses and found coronary heart disease risk was reduced by 30 percent for those who had fish one to three times per month, 40 percent for once per week, 36 percent for two to four times per week, and 64 percent for five or more times per week. Researchers also noted a reduced risk of total mortality for higher fish consumption, as well as a reduced risk of coronary heart disease and total mortality for long-chain omega-3 consumption.

Like the omega-3s and omega-6s, conjugated linoleic acid (CLA) is a healthy fat that may improve parameters of health in diabetic subjects. One double blind study of 21 diabetic patients showed mixed CLA isomers decreased fasting blood sugar in nine of 11 subjects taking CLA compared to two of nine subjects taking placebo.⁷⁸ CLA treatment was also associated with reductions in body weight and serum leptin (a hormone that is thought to regulate fat levels). [Editors note: This study received support from Lake Bluff, Ill.-based Pharmanutrients and Chicagobased Natural Inc.] In addition to reducing body fat, CLA is believed to reduce insulin sensitivity.⁷⁹

The natural products industryfrom vitamins and minerals to mushrooms and fish oilhas the means by which to prevent diabetes, as well as to help manage it. Natural products, as part of a healthy lifestyle, can prevent diabetes and keep it from being a debilitating or fatal condition. Prevention is the key to stemming this unfolding epidemic, said Julie Gerberding, director of the Centers for Disease Control and Prevention. By eating a healthy diet and engaging in regular physical activity, individuals can greatly reduce their risk of developing Type II diabetes.

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