Diabetes

Diabetes
by Elizabeth Srejic

Rather than turning immediately to pharmaceuticals for diabetes care, health care practitioners and patients are investigating alternative treatments and nutritional compounds to help control the symptoms of this insidious disease.

Diabetes is a collection of diseases distinguished by high levels of blood glucose caused by defective insulin production and/or action, often responsible for severe health problems and early death. Fortunately, patients with diabetes can possibly reduce or forgo use of prescription drugs in favor of gentler lifestyle changes such as exercising, maintaining a healthy weight and taking dietary supplements to help control symptoms and lower the risk of complications.

Scientists classify diabetes into several varieties, the most common being Type I and Type II. Type I diabetes, known previously as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5 percent to 10 percent of all diagnosed cases of diabetes.¹ Type I diabetes occurs when the body’s immune system destroys pancreatic beta cells, manufacturers of the vital hormone insulin, a blood glucose regulator.Patients with this variety of diabetes, typically children and young adults, must take regular doses of exogenous insulin, delivered by injection or pump, to control their blood sugar. Risk factors for Type I diabetes may be autoimmune, genetic or environmental, and currently there is no cure for the disease.² However, according to the Centers for Disease Control (CDC), several clinical trials investigating preventive measures for Type I diabetes are currently in progress or being planned.³

Type II diabetes, formerly called non-insulindependent diabetes mellitus (NIDDM) or adult-onset diabetes, accounts for between 90 percent to 95 percent of all diagnosed cases of diabetes.⁴ Type II diabetes normally develops when cells lose the ability to use insulin correctly, a disorder known as insulin resistance. As the need for insulin heightens, the disease gradually saps the ability of the pancreas to produce insulin. Risk factors for Type II diabetes include old age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism and physical inactivity. In addition, ethnicity may play a role in development of Type II diabetes; ethnic groups particularly prone to the disease and its complications include blacks, Hispanics, American Indians and certain Asian Americans, as well as native Hawaiians and other Pacific Islanders.⁵

In addition to Type I and Type II diabetes, many women are prone to gestational diabetes, a form of temporary glucose intolerance. It is more common among women of black, Hispanic and American Indian ethnicities; in addition to race, other risk factors include obesity and family history of diabetes.⁶ After pregnancy, 5 percent to 10 percent of women who develop gestational diabetes subsequently contract Type II diabetes, with a 20 percent to 50 percent chance of developing the disease in the five to 10 years subsequent to delivery.⁷ Finally, there are other forms of diabetes that can develop in conjunction with specific genetic conditions, surgery, drugs, malnutrition, infections and other illnesses.

According to CDC, 20.8 million individuals (14.6 million diagnosed; 6.2 million undiagnosed), or 7 percent of the U.S. population, suffer from some form of diabetes.⁸ In 2002, diabetes was the sixth leading cause of death in the United States.⁹ However, CDC also reported diabetes is likely to be underreported as a cause of death. Studies have found diabetes was noted on death certificates of only 30 percent to 40 percent of decedents with diabetes, and only 10 percent to 15 percent of those certificates listed the disease as the underlying cause of death.¹⁰ Overall, the risk for death from diabetes is roughly twice that of individuals of similar age without diabetes.¹¹

Left untreated, diabetes can produce debilitating complications. Heart disease and stroke account for approximately 65 percent of deaths in patients with diabetes.¹² High blood pressure (typically greater than or equally to 130/80 mm Hg) presents in up to threequarters of adults with diabetes.¹³ Diabetic retinopathy, a form of blindness, occurs frequently in patients with diabetes and is the leading cause of blindness among adults aged 20 to 74 years.¹⁴ Kidney disease goes hand-in-hand with diabetes (diabetic nephropathy), the leading cause of kidney failure, accounting for 44 percent of new cases in 2002.¹⁵ Nervous system disease also accompany diabetes (diabetic neuropathy), as the disease causes nervous system damage in 60 to 70 percent of its victims.¹⁶ Amputations are yet another byproduct of diabetes, comprising 60 percent of non-traumatic lower-limb amputations.¹⁷ Dental disease is also common in diabetics, as periodontal disease frequently accompanies diabetes.¹⁸ Pregnancy complications can occur in women with diabetes, as failure to control the disease prior to conception and in the first trimester of pregnancy can cause significant birth defects and spontaneous abortions.¹⁹ In addition, diabetes causes other complications, including biochemical imbalances leading to acute life-threatening events such as coma, as well as a generally compromised immune system.²⁰

Currently, there is no cure for diabetes. The use of prescription drugs can help control diabetes symptoms and keep the disease from progressing; however, diabetes patients can also adopt various lifestyle changes to help control the disease.

One of the first lifestyle changes recommended to diabetics by health care practitioners is to follow guidelines for good general health, including partaking in regular physical activity, avoiding smoking, maintaining a healthy body weight, consuming a diet rich in whole grains, fruits, vegetables and omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs), and avoiding saturated fats. Another basic recommendation for diabetics is to take a multivitamin/mineral dietary supplement to promote good general health; enhanced vitamin and mineral status can help boost immune function and ward off opportunistic infections that often strike diabetes patients. One study supporting this recommendation was conducted by researchers at Wake Forest University School of Medicine, who found patients with Type II diabetes suffered significantly fewer infections over the course of a year when they took a multivitamin/mineral supplement.²¹

In addition to taking multivitamins/minerals, practitioners also recommend diabetics adopt lifestyle changes designed to promote good cardiovascular health, particularly by lowering blood pressure and serum lipid levels. In general, for every 10 mm Hg reduction in systolic blood pressure, the risk of developing any complication related to diabetes is reduced by 12 percent, while improved control of low-density lipoprotein (LDL) cholesterol and triglycerides can reduce cardiovascular complications by 20 percent to 50 percent.²²

Another lifestyle change diabetics can pursue to help control the disease is managing blood glucose levels through diet. Generally, among diabetics, each 1-percentage-point reduction in blood sugar causes a 40-percent reduction in the risk of microvascular complications including eye, kidney and nerve diseases.²³ Manufacturers are recognizing the push to adopt healthy glycemic practices by producing a wide array of low-glycemic index (GI) functional food offerings, while suppliers are developing and introducing ingredients designed to modulate blood sugar.

In general, diets lacking adequate dietary fiber may put individuals at risk of developing Type II diabetes. According to an eight-year study investigating the association between dietary fiber intake, glycemic index and the risk of developing Type II diabetes among 90,000 women, researchers at the Harvard School of Public Health found GI was significantly associated with an increased risk of developing Type II diabetes, while cereal fiber intake decreased the risk.²⁴ Another study suggesting a beneficial relationship between fiber consumption and lower risk of diabetes was conducted by researchers at the National Public Health Institute of Helsinki, who found in a 10-year follow-up study that higher intake of whole grain and cereal fiber significantly reduced the risk of developing Type II diabetes in more than 4,200 adults.²⁵

Finnish researchers from the University of Kuopio conducted a randomized, controlled, repeated measures trial to investigate the effects of high-beta-glucan oat bran flour (as Natureal, from GTC Nutrition) on patients with Type II diabetes.²⁸ Twelve Type II diabetic patients were randomly administered oat bran flour, oat bran crisp and a glucose load providing 12.5 g glycemic carbohydrate (Series 1), and 25 g glucose load alone and 25 g glucose load with 30 g oat bran flour (Series 2). Study participants undertook five two-hour meal glucose tolerance tests on separate occasions. The results indicated oat bran flour high in beta-glucan had a low glycemic response and decreased postprandial glycemic response of an oral glucose load in subjects with Type II diabetes. Canadian researchers similarly evaluated the long-term effects of oat bran concentrate on free-living subjects with Type II diabetes, in which eight men were administered a bread containing oat bran concentrate (soluble fiber [beta-glucan] content = 22.8 percent), followed by a white bread control in the second phase of the trial.²⁹ Test subjects’ mean total plasma cholesterol and LDL cholesterol levels were lower in the oat bran concentrate period than in the white bread period of the study, and the mean ratio of LDL cholesterol to HDL cholesterol was reduced by 24 percent in the oat bran concentrate phase of the trial.The researchers concluded the oat bran concentrate bread products improved lipidemic as well as glycemic and insulinemic responses and noted at bran may help diabetics through its ability to lower total and LDL cholesterol.

Beta-glucan from barley has also been shown clinically to reduce serum lipid levels. According to a six-week study presented in April 2005 at the First International Congress on Pre-Diabetes and Metabolic Syndrome, 76 men and 79 women with hypercholesterolemia, aged 25 to 73, completed a four-week low-fat diet prior to baseline.³⁰ At the beginning of the trial, test subjects were randomly allocated to one of four treatment groups or a control group and assayed for blood lipids and other cardiovascular disease (CVD) biomarkers. During the course of the study, test groups were administered cereal and juice fortified with 3 g and 5 g doses of low molecular weight (LMW) or high molecular weight (HMW) barley betaglucan (from Cargill) twice daily. Post-treatment assessment of blood lipids and other CVD biomarkers revealed improvements in LDL cholesterol, triglycerides and markers of glycemic control, among other benefits. In addition, a clinical study presented at the 2005 American Heart Association’s (AHA) Scientific Sessions and slated for publication in Circulation, suggested barley beta-glucan (from Cargill) had cholesterol-lowering properties similar to oats.³¹ And another study on barley beta-glucan (from Cargill) presented at the same conference suggested barley beta-glucan has benefits beyond cholesterol reduction, including improved glycemic control, particularly among individuals with metabolic syndrome, who are at greater risk of developing Type II diabetes and cardiovascular disease. ³²

In addition to producing low-GI functional foods and ingredients marketed for blood glucose control, suppliers and manufacturers have flooded the market with a number of low- or no-calorie sugarreplacements intended for stand-alone use as dietary supplements or inclusion in functional foods. A few of these ingredients include luo han kuo (LHK), an Asian botanical with naturally sweet fruits; stevia, another naturally sweet plant-sourced product that can be used in dietary supplements; and erythritol, a polyol (sugar alcohol) also known to inhibit tooth decay.

LHK may have benefits for diabetics beyond its capabilities as a sweetener, as it may help diabetics control serum lipids. According to clinical research, fruits of the botanical contain antioxidants that inhibit oxidation of LDL cholesterol.³³ Studies on stevia confirm the product’s benefits for diabetics. Researchers from Aarhus University Hospital in Denmark supplemented Type II diabetic subjects with either 1 g of stevioside or 1 g of maize starch (control) with a meal.³⁴ After measuring blood samples taken before and four hours after eating the meal, the researchers found stevioside reduced postprandial blood glucose levels, indicating beneficial effects on glucose metabolism, and concluded stevioside may be advantageous in the treatment of Type II diabetes. Further, the same researchers found stevioside reduced levels of blood-sugar-raising glucagon as well as systolic and diastolic blood pressure in a diabetic rat model.³⁵

The use of erythritol among diabetics is also validated by clinical research. Russian researchers investigated the influence of a diet supplemented with erythritol on basal and postprandial glycemia, lipid levels, blood pressure and body weight in 30 patients with Type II diabetes, and found administration of 30 g/d of the sweetener as part of a traditional hypocaloric diet did not decrease the efficacy of dietary therapy or increase blood glucose levels in patients with Type II diabetes, in comparison with an isomalt control (30 g/d).³⁶ And, beyond its sweetening effects, erythritol has been shown to attenuate oxidative stress related to diabetes by modulating glucose metabolism and lipid peroxidation in rats with diabetes induced by streptozotocin.³⁷

Among the many dietary ingredients proven efficacious for blood glucose control in clinical trials is chromium, a mineral shown to enhance the body’s utilization of insulin. A study conducted at the Pennington Biomedical Research Center in Baton Rouge, La., and presented at the 2005 Meeting of the European Association for the Study of Diabetes (EASD) in Athens, Greece, found in vitro administration of chromium picolinate (as Chromax®, from Nutrition 21) to skeletal muscle cells increased levels of the metabolic enzyme AMPactivated protein kinase (AMPK), improving energy balance and insulin function.³⁸ A multi-center study in India further found chromium supplementation seemed to improve glycemic control in Type II diabetes patients, apparently due to an increase in insulin action.³⁹ And a study conducted by a group of U.S. Department of Agriculture (USDA) and other researchers found 500 mcg/d supplemental chromium picolinate (from Nutrition 21) improved fasting glucose, postprandial glucose, insulin, hemoglobin A1c and cholesterol status in 180 people with Type II diabetes.⁴⁰

The combination of chromium picolinate and biotin may have beneficial effects on blood glucose. Coadministration of chromium picolinate and biotin (as Diachrome®, from Nutrition 21) and prescription treatment regimens to Type II diabetics produced a 0.7-percent to 1.9-percent point reduction in HbA1c levels as well as significantly reduced insulin resistance.⁴¹ Further, a clinical study sponsored by Nutrition 21 and presented at an annual meeting of the American College of Nutrition showed patients with Type II diabetes consuming a combination of chromium picolinate and biotin (as Diachrome) twice daily experienced reduced blood sugar levels and fatigue.⁴² Chromium picolinate formulated with biotin also lowers CVD risk factors in Type II diabetics, according to research presented at the American Heart Association’s sixth Annual Conference on Arteriosclerosis, Thrombosis and Vascular Biology.⁴³ In the randomized double blind, placebo-controlled, multi-center study, 368 Type II diabetes patients received a placebo or chromium picolinate and biotin (as Diachrome) for 12 weeks. Non-high-density lipoprotein (HDL) cholesterol was significantly lowered (by 14 mg/dL) in Type II diabetes patients already receiving statin therapy or other cholesterollowering prophylaxes, compared to the placebo group. In addition, test subjects who took Diachrome had significantly lower triglyceride levels (225 mg/dL) compared to individuals in the placebo group (278 mg/dL).

Another form of chromium, chromium polynicotinate (or niacin-bound chromium, as ChromeMate®, from InterHealth Nutraceuticals) has been studied for its beneficial effects in diabetes. A rat study conducted at Georgetown University found diabetic rats given niacin-bound chromium (as ChromeMate), zinc monomethionine (as LOptiZinc ®, from InterHealth) and a grape seed extract had significantly greater insulin sensitivity and lower markers of blood glucose.⁴⁴ Chromium polynicotinate was also shown to promote healthy glucose metabolism in animals and humans in a double blind human investigation, where two groups of volunteers received either 300 mcg/d of chromium polynicotinate (as ChromeMate) or placebo daily for three months.⁴⁵ Individuals given chromium polynicotinate had significantly lowered fasting glucose levels, whereas glucose levels did not change in the placebo group. Test subjects given the active treatment also experienced modest decreases in triglyceride levels and glycosylated hemoglobin, a marker of long-term glucose control.

The mineral magnesium may also be important for diabetics. A Taiwanese study found an inverse association between plasma magnesium concentration and prevalence of diabetes in a national population-based crosssectional nutrition survey.⁴⁶ And researchers from Harvard found an inverse association between consumption of magnesium and the risk of developing Type II diabetes, as lower fasting insulin concentrations accompanied higher magnesium intake.⁴⁷

Antioxidant micronutrients also appear critical in helping diabetics maintain good health. Coenzyme Q10 (CoQ10) may positively affect cardiovascular health in diabetics. Scientists from Perth, Australia found CoQ10 supplementation may improve blood pressure and long-term glycemic control in Type II diabetics.⁴⁹ Seventy-four subjects with uncomplicated Type II diabetes and dyslipidemia were randomly assigned to receive an oral dose of 100 mg CoQ10 twice daily, 200 mg/d fenofibrate (a lipid regulating agent), both or neither for 12 weeks. Whereas fenofibrate administration did not alter blood pressure, CoQ10 significantly decreased systolic and diastolic blood pressure. Additional Australian research found CoQ10 supplementation dilated the brachial artery of dyslipidemic subjects with Type II diabetes, leading the researchers to conclude CoQ10 supplementation in dyslipidemic Type II diabetics improves the endothelial function of conduit arteries involved in peripheral circulation.⁵⁰

Taking the potent antioxidant alpha-lipoic acid (ALA) may inhibit diabetic neuropathy, a peripheral nerve disorder. Researchers from the Russian Medical Academy for Advanced Studies, Moscow, randomized metabolicallystable diabetic patients with symptomatic (stage 2) diabetic sensorimotor polyneuropathy (DSPN) to receive 600 mg/d ALA or placebo for five days/week for 14 treatments. After 14 treatments, the Total Symptom Score (TSS), a measure of positive neuropathic sensory symptoms of the ALA group had improved from baseline by an average of 5.7 points, whereas the placebo group’s TSS had improved by an average of 1.8 points. The researchers concluded ALA appears to be a useful ancillary treatment for the symptoms of diabetic polyneuropathy because of its safety profile and its effect on positive neuropathic sensory symptoms and other neuropathic end points.⁵¹ German researchers reported similar findings after treating 35 patients (20 with Type I diabetes, 15 with Type II diabetes) with 600 mg/d ALA for 18 months of follow-up.⁵² The researchers found plasma thrombomodulin level decreased and the urinary albumin concentration (UAC) increased in patients given ALA, whereas plasma thrombomodulin increased and UAC remained unchanged in a control group, indicating diabetics given ALA benefited from the antioxidative effects of ALA. The scientists noted progression of diabetes might be inhibited by antioxidants.

Beyond micronutrients, there are many botanical extracts that may benefit diabetics. Consumption of cinnamon may help control glucose levels as well as other symptoms of diabetes. Cinnamon’s blood-sugar-balancing capabilities may be a function of the compound’s double-linked Type-A polymers. A USDA Agricultural Research Service study found intake of 1 g/d of cinnamon may reduce blood sugar in Type II diabetes patients not taking insulin.⁵³ Researchers divided 60 subjects randomly into six groups, where they consumed 1 g/d, 3 g/d or 6 g/d of cinnamon or placebo for 40 days. Blood sugar, cholesterol and triglyceride levels improved by an average of 20 percent in subjects who ate as little as 1 g/d of cinnamon; higher intakes did not augment the results. Researchers also noted blood sugar levels rebounded when subjects stopped taking cinnamon. And results of a double blind, placebo-controlled trial conducted by Ohio Research Group showed pre-diabetics supplemented with cinnamon extract (as Cinnulin PF™, from Integrity Nutraceuticals) showed statistically significant decreases in fasting blood glucose levels, marked improvements in insulin sensitivity and no statistically significant changes in clinical blood chemistries.⁵⁴

Use of banaba is gaining popularity among diabetics due to the herb’s purported ability to balance blood glucose. The antidiabetic activity of banaba was demonstrated in a proprietary, randomized, double blind trial from OptiPure, where 12 Type II diabetics (six men and six women with blood sugar between 140 and 250 mg/dl, and aged between 55 and 76 years) were administered a 1-percent corosolic acid concentration of banaba (as GlucoTrim®, from OptiPure) at sequential doses of 16, 32 and 48 mg for 15-day periods, with 10-day washout periods between doses. Subjects refrained from taking oral hypoglycemic medication for an average of 45 days preceding baseline and maintained their usual diets during the study. Compared to control, diabetics who took banaba showed a statistically significant drop in blood glucose levels at the dose of 48 mg banaba.

A growing number of in vitro and in vivo studies have indicated aloe vera may have notable antidiabetic activity. A human, placebo-controlled, single blind trial clinical trial conducted at the Mahidol University of Bangkok, Thailand, conducted on 72 patients with high fasting blood sugar and typical diabetic curve of glucose tolerance, who had never been treated with hypoglycemic drugs, found oral aloe supplementation had beneficial effects on blood sugar, cholesterol and triglycerides.⁵⁶ The treatment group received 15 mL of aloe gel twice daily, in the morning and before bedtime, for 42 days. Blood samples were taken weekly for measurement of fasting blood glucose levels and every two weeks for triglyceride and cholesterol analyses. Before treatment, there were no significant differences in blood markers between the groups. After treatment, blood sugar in the treatment group was lowered by 43 percent and blood triglycerides were reduced by 44 percent.

Another route to glucose homeostasis among diabetics may be consumption of gymnema. Indian researchers from the Postgraduate Institute of Basic Medical Sciences, Madras, investigated the effects of 400 mg/d gymnema (as ProBeta, from PharmaTerra Inc.) for 18 to 20 months on hyperglycemia in 22 Type II diabetes patients undergoing simultaneous treatment with conventional oral anti-hyperglycemic agents.⁵⁷ During gymnema supplementation, diabetic patients showed a significant reduction in blood glucose, glycosylated hemoglobin and glycosylated plasma proteins, and were able to decrease their intake of conventional antihyperglycemia drugs. Five of the 22 diabetics were able to discontinue their conventional drug and maintain their blood glucose homeostasis with gymnema alone. The researchers concluded pancreatic beta cells may be regenerated or repaired in Type II diabetic patients given gymnema and noted this conclusion was supported by the appearance of elevated insulin levels in the serum of patients after gymnema supplementation.

Another botanical-based ingredient touted for blood sugar control is extract of French maritime pine bark (as Pycnogenol®, from Natural Health Science). Administered in conjunction with standard anti-diabetic treatment, the extract lowered blood glucose and improved endothelial function in Type II diabetic patients.⁶¹ In the double blind, placebo-controlled, randomized, multi-center study, 77 Type II diabetic patients were administered 100 mg/d of French maritime pine bark extract (as Pycnogenol) for 12 weeks, as an adjunct to conventional anti-diabetic therapy. Pycnogenol significantly lowered plasma glucose levels as compared to placebo, and improved various markers of endothelial function, including decreased endothelin-1 and increased 6-ketoprostaglandin F(1 alpha).

Supplementation with Pycnogenol may also help diabetics maintain eye health. Italian researchers investigated the effects of Pycnogenol on the progression of diabetic retinopathy and other vascular retinal disorders.⁶² Forty patients with diabetes, atherosclerosis and other vascular diseases involving the retina were enrolled and received placebo or 50 mg three times daily of Pycnogenol. Subjects given placebo experienced a gradual progression of retinopathy and significant decline in visual acuity, whereas Pycnogenol-treated patients showed no deterioration of retinal function and a significant recovery of visual acuity. The researchers noted the mechanism of action of Pycnogenol may be related to its free-radical-scavenging, anti-inflammatory and capillary protective activities and suggested Pycnogenol may bind to the blood vessel wall proteins and mucopolysaccharides and produce a capillary sealing effect, leading to reduced capillary permeability and edema formation.

According to numerous clinical trials, bioactive substances present in maitake mushroom may ameliorate certain symptoms of diabetes. Japanese researchers conducting an animal study found administration of 20-percent maitake diets improved insulin concentration, organ weight, serum composition and islets of Langerhans in streptozotocin-induced diabetic rats.⁶³ Another Japanese rodent study found oral administration of a certain glycoprotein fraction of maitake (as SX-Fraction™, from Maitake Products Inc.) to genetically diabetic mice caused reductions in blood glucose, insulin and triglyceride in comparison to a control group.⁶⁴ The eight-week study showed control mice had higher blood glucose, insulin, triglyceride and body weight from baseline than maitake-fed animals. Supplementation with vitamins, minerals, botanicals and other natural compounds may comprise gentle treatment programs for patients with diabetes, and could possibly replace or complement use of prescription drugs among some diabetes patients.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines